Nurse practitioner integration: Qualitative experiences of the change management process

Lowe, Grainne; Plummer, Virginia; Boyd, Leanne

doi:10.1111/jonm.12624

Cited by 25 publications

(37 citation statements)

References 34 publications

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“…In a related vein, perspectives regarding these professionals’ scope of practice have previously been identified, whether related to the interpretation of this scope by physicians [17, 27] or registered nurses [17, 19] or to PHCNPs’ beliefs that their scope of practice is unduly limited [14, 16, 45]. The tension between the biomedical and nursing paradigms has been noted in some other investigations [13, 14, 19, 46]. Some other studies also have identified a lack of congruence between the reality of PHCNPs’ roles and the structures in which their practice is situated.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the factors that have been identified include: reimbursement policies [7, 13–15]; scope of practice clarity [7, 14, 16]; role definition, comprehension and recognition [7, 13, 14, 17–20]; integration process into primary care settings [21, 22]; organisational/administrative support [7, 13, 14, 18, 20, 23, 24]; work climate [25]; team functioning in general [26] and collaboration between APNs and physicians [13, 17, 19, 27–29] and with registered nurses and other professionals [16, 17, 19]. Studies have demonstrated the positive impact associated with adopting an systematic process to implementing the PHCNP role [19, 21]. In a related vein, others have noted the importance of considering multiple levels (e.g., organisational, health care system) in better understanding the elements needed for an optimal implementation [3, 16, 30, 31].…”

Section: Introductionmentioning

confidence: 99%

“…Although some attention has been paid to identifying and describing multiple factors (e.g., work organisation dimensions; physician remuneration), limited attention has been given to the dynamic interaction between the individual, the organisation and the broader health system context [16, 19, 30, 31]. The interdependence between these different levels can shape a particular context that evolves over time and is a source of both constraints and possibilities.…”

Section: Introductionmentioning

confidence: 99%

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New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning

Côté

Freeman

Jean

et al. 2019

BMC Health Serv Res

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BackgroundOptimising health professionals’ contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada).MethodsWe used Giddens’ structuration theory to guide our study given its’ facilitation of the understanding of the dynamic between structural constraints and actors’ actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016–2017.ResultsForty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others’ inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs’ sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity).ConclusionSeveral new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning

Côté

Freeman

Jean

et al. 2019

BMC Health Serv Res

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“…The nurse practitioner role has been associated with extensive research to date primarily describing work practices. Integration relates to the normalization of the nurse practitioner becoming embedded in‐service delivery and differs from nurse practitioner roles as pilot or test initiatives (Lowe et al, 2018). The integration of nurse practitioner roles depends on a structured, multilevel support system to ensure they are embedded within the service rather than an ‘add on’ (Contandriopoulos et al, 2015; Lowe et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland

Ryder

Gallagher²

2022

J Nursing Management

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Aim The purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland. Background A recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term. Method An electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland. Results Sixty‐six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty‐two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants. Conclusions This research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized. Implications for Nursing Management Failure to successfully integrate the nurse practitioner role risks the long‐term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

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“…The NP role, conceived in the United States over 50 years ago, has been seen to include both leadership, by implementing quality patient care practices, and research, by investigating the outcomes of care provided (Ford, 2015; Lowe, Plummer, & Boyd, 2018; Ryder et al, 2019). Leadership outcome indicators for NPs identified by Elliott et al (2014) include research in the form of research application, evaluation and knowledge generation.…”

Section: Introductionmentioning

confidence: 99%

An integrative review to identify evidence of nurse practitioner‐led changes to health‐care delivery and the outcomes of such changes

Ryder

Jacob

Hendricks

2020

Int J of Nursing Practice

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Aims This study aimed to identify evidence of nurse practitioner‐led changes to health‐care delivery and the outcomes of such changes. Background Changing health‐care delivery is synonymous with the nurse practitioner role. The literature is critical of the lack of research by nurse practitioners, reporting the effects of a change to health‐care delivery. Design This study used a systematic integrative review by using Torraco's approach. Data sources Databases Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Web of Science and SCOPUS were searched for peer‐reviewed publications from 2000 to 2019. Review Methods A systematic approach was used to screen and analyse the literature. Inclusion/exclusion criteria were applied, and quality appraisal was undertaken by two reviewers. Results Eighteen articles were selected. The research projects were across the community and acute care settings. Research methodologies varied including preintervention and postintervention studies, evaluation of quality improvement projects, randomized controlled trial and descriptive studies. Multiple data collection tools were used. Two major themes were identified including evidence‐based practice champions and improved patient outcomes. Conclusion The nurse practitioner role is pertinent toward improving evidence‐based practice in clinical settings. Positive patient outcomes and praise for clinical leadership are evident in the literature. Research by nurse practitioners to date has focused on individual services.

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Nurse practitioner integration: Qualitative experiences of the change management process

Cited by 25 publications

References 34 publications

New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning

New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland

An integrative review to identify evidence of nurse practitioner‐led changes to health‐care delivery and the outcomes of such changes

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