Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care

Kraus, Elena; DuBois, James M.

doi:10.1007/s11606-016-3896-7

Cited by 54 publications

(75 citation statements)

References 18 publications

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“…Ambiguity of JNPs' position in the legal system Our results indicated that JNPs carefully determined whether they were able to perform certain medical procedures and assessed the di culty of a medical practice when they were asked to perform tasks on a doctor's behalf. Our results were identical to those of a previous study showing that the law was a barrier to NPs' independent practice [15]. JNPs practice medical procedures in training; therefore, they are able to implement the procedures if they intend to do so [20].…”

Section: Discussionsupporting

confidence: 87%

“…For example, in cases in which NPs and physicians work together, although NPs' activities are evaluated by the doctor, there is some overlap in their scope of practice (i.e., NPs can prescribe drugs and perform some, but not all, advanced medical practices) [13], making the issue of legal liability vague [14]. Additionally, NPs are legally unable to independently perform advanced medical procedures [15]. Although NPs are an integral part of medical teams in emergency departments, they must have su cient practical ability to ensure the medical practice safety and avoid litigation [16].…”

mentioning

confidence: 99%

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Japanese Nurse Practitioners’ Legal Liability Ambiguity Regarding their Medical Practice: A Qualitative Study

Sugiyama

Asakura

Takada

2020

Preprint

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Background: Nurse practitioners’ role is always expanding. The Japanese Nurse Practitioner (JNP) system was initiated in 2015 to shift some aspects of doctors’ work to various other healthcare professionals, including nurses. JNPs’ fulfillment of their roles was shown to have a certain degree of efficacy and provide positive outcomes for patients (e.g., shortening hospitalization period). Nurse practitioners are considered legally liable for their medical practices because they are performed on doctors’ behalf; however, in real life, there is ambiguity regarding such practice. It is necessary to clarify nurse practitioners’ legal liability in order to ensure the safety of their medical practice and protect them in medical procedures performed on physicians’ behalf. This study aimed to clarify how JNPs understand their own legal liability in medical practice.Methods: A qualitative, inductive research design was adopted to record participants’ opinions. The survey was conducted from October 2017 to February 2018. Participants were nurses working as JNPs at general hospitals in eastern Japan. We recruited participants via snowball sampling.Results: With regard to JNPs’ legal liability in their medical practice, three themes understanding were observed: “determining whether the JNP has the ability to perform the assigned medical procedure,” “exercising caution when performing medical procedures on a doctor’s behalf” and “an urge to follow up with appropriate medical practice until the end of care.”Conclusions: We demonstrated that JNPs recognized their own legal liability in medical practice. They had to protect themselves because their legal position was ambiguous. Furthermore, JNPs accepted that diagnosis and drug prescription could be performed (even if not within the 38 procedures JNPs are qualified to perform) on behalf of doctors if trusting relationships had been previously established.

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

Japanese Nurse Practitioners’ Legal Liability Ambiguity Regarding their Medical Practice: A Qualitative Study

Sugiyama

Asakura

Takada

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…38 In addition, pediatric oncologists themselves may recommend that patients seek medical care from PCPs for minor illnesses, especially for patients living long distances from pediatric oncology centers, and during less intensive phases of treatment (eg, maintenance therapy for patients with acute leukemia). 42 Provider experience (older age and larger number of patients seen per week) was associated with greater comfort in independently providing health maintenance care to survivors. This is highlighted further by the large percentage of PCPs in the current survey who indicated that they would call the oncologist for recommendations when caring for an on-therapy patient with childhood cancer with an acute illness.…”

Section: Discussionmentioning

confidence: 99%

“…41 We also found that physicians were significantly more comfortable than advanced-level practitioners in providing acute medical care to on-therapy patients, suggesting that more extensive training may have an impact on comfort level in caring for patients with complex chronic illnesses. 42 Provider experience (older age and larger number of patients seen per week) was associated with greater comfort in independently providing health maintenance care to survivors. In the current study, female providers were more likely to indicate increased comfort when providing health maintenance care for survivors in collaboration with pediatric oncologists compared with male providers.…”

Section: Discussionmentioning

confidence: 99%

Providing health care for patients with childhood cancer and survivors: A survey of pediatric primary care providers

Wadhwa

Chen

Bhatia

et al. 2019

Cancer

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BACKGROUND:The current study was conducted to assess self-reported comfort levels of pediatric primary care providers (PCPs) in providing acute medical care to patients with childhood cancer who currently were receiving therapy (on-therapy patients) and health maintenance care to childhood cancer survivors, independently and in conjunction with pediatric oncologists, along with confidence levels regarding knowledge about immunizations for survivors. All levels were measured using 7-point Likert scales. METHODS: A cross-sectional, 23-item survey mailed to practicing PCPs affiliated with a tertiary children's hospital was analyzed. RESULTS: The response rate was 64.4% (259 of 402 eligible PCPs). The mean PCP comfort level was higher when collaborating with a pediatric oncologist to provide acute medical care for on-therapy patients and health maintenance care for childhood cancer survivors (mean ratings of 6.0 ± 1.5 and 6.4 ± 1.3, respectively) compared with independently providing such care (mean ratings of 4.6 ± 1.8 and 5.0 ± 1.7, respectively; P < .0001). Only approximately 30% of PCPs were confident in their knowledge regarding immunizations for survivors. Certain factors were found to be associated with PCP comfort in providing care in conjunction with a pediatric oncologist. For acute care, these factors were rural location compared with urban location (odds ratio [OR], 5.0; 95% CI, 1.9-13.1 [P = .03]) and having cared for ≥6 on-therapy patients within the past year versus none (OR, 3.8; 95% CI, 1.9-7.5 [P = .0001]). For survivor health maintenance care, practice location <50 miles from pediatric oncology specialty care versus ≥50 miles was the only factor found to be associated with PCP comfort (OR, 2.8; 95% CI, 1.3-6.1 [P = .009]). CONCLUSIONS: The findings of the current study underscore the need for collaboration between pediatric oncologists and PCPs when caring for children with cancer across the spectrum of care. Cancer 2019;125:3864-3872.

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“…For example, in cases in which NPs and physicians work together, although NPs' activities are evaluated by the doctor, there is some overlap in their scope of practice (i.e., NPs can prescribe drugs and perform some, but not all, advanced medical practices) [13], making the issue of legal liability vague [14]. Additionally, NPs are legally unable to independently perform advanced medical procedures [15]. Although NPs are an integral part of medical teams in emergency departments, they must have sufficient practical ability to ensure the medical practice safety and avoid litigation [16].…”

mentioning

confidence: 99%

Japanese nurse practitioners’ legal liability ambiguity regarding their medical practice: a qualitative study

2020

View full text Add to dashboard Cite

Background: Nurse practitioners' role is always expanding. The Japanese Nurse Practitioner (JNP) system was initiated in 2015 to shift some aspects of doctors' work to various other healthcare professionals, including nurses. JNPs' fulfillment of their roles was shown to have a certain degree of efficacy and provide positive outcomes for patients (e.g., shortening hospitalization period). Nurse practitioners are considered legally liable for their medical practices because they are performed on doctors' behalf; however, in real life, there is ambiguity regarding such practice. It is necessary to clarify nurse practitioners' legal liability in order to ensure the safety of their medical practice and protect them in medical procedures performed on physicians' behalf. This study aimed to clarify how JNPs understand their own legal liability in medical practice. Methods: A qualitative, inductive research design was adopted to record participants' opinions. The survey was conducted from October 2017 to February 2018. Participants were nurses working as JNPs at general hospitals in eastern Japan. We recruited participants via snowball sampling. Results: With regard to JNPs' legal liability in their medical practice, three themes understanding were observed: "determining whether the JNP has the ability to perform the assigned medical procedure," "exercising caution when performing medical procedures on a doctor's behalf" and "an urge to follow up with appropriate medical practice until the end of care." Conclusions: We demonstrated that JNPs recognized their own legal liability in medical practice. They had to protect themselves because their legal position was ambiguous. Furthermore, JNPs accepted that diagnosis and drug prescription could be performed on behalf of doctors if trusting relationships had been previously established.

show abstract

Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care

Cited by 54 publications

References 18 publications

Japanese Nurse Practitioners’ Legal Liability Ambiguity Regarding their Medical Practice: A Qualitative Study

Japanese Nurse Practitioners’ Legal Liability Ambiguity Regarding their Medical Practice: A Qualitative Study

Providing health care for patients with childhood cancer and survivors: A survey of pediatric primary care providers

Japanese nurse practitioners’ legal liability ambiguity regarding their medical practice: a qualitative study

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