Nurse practitioners as a solution to transformative and sustainable health services in primary health care: A qualitative exploratory study

Carryer, Jenny; Adams, Sue

doi:10.1016/j.colegn.2016.12.001

Cited by 84 publications

(46 citation statements)

References 37 publications

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“…31 Population-based strategies to improve health outcomes through increased access and reduced inequalities have been identified as central to the role of NPs. 32 To fulfil their role, the NPs endeavoured to provide appropriate and accessible PHC services for the population they served. Improved health outcomes were made possible through a person-centred service, with particular concern expressed about the inadequacies of the traditional bio-medical model for meeting the needs of under-served populations.…”

Section: Discussionmentioning

confidence: 99%

Thinking about health care differently: nurse practitioners in primary health care as social entrepreneurs

Kirkman¹,

Wilkinson

Scahill

2018

J Prim Health Care

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INTRODUCTIONChallenges facing the primary health-care sector mean that policymakers and clinicians need to think and act differently to move forward. The principles of social entrepreneurship have been implemented successfully for improved health outcomes in other developed nations. There is a knowledge gap around whether nurse practitioners (NPs) in New Zealand primary health care (PHC) align with these principles. AIMTo explore whether and how the innovative activities of primary care NPs can be described as socially entrepreneurial. METHODSA descriptive qualitative approach was used with data collected using semi-structured interviews with NPs working in primary care (n = 7). Data were analysed using general inductive thematic analysis techniques. RESULTSNurse practitioners interviewed worked in government-subsidised private general practice businesses. Two main themes emerged: (1) the nursing model of care aligned with social entrepreneurship; and (2) building social capital. NPs described a desire to see health care delivered differently and this aligned with acting as a social entrepreneur. Social capital emerged through the requirement to establish significant collaborative relationships. DISCUSSIONIt was found that NPs’ work can be described as socially entrepreneurial. The holistic, person and community-centred model of NP care has an ultimate mission of improved health outcomes. Social capital is built through collaborative relationships with other health-care providers, individual service users and the community. However, the juxtaposition of the business model in primary care prevents NPs from initiating and leading sustainable change.

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Section: Discussionmentioning

confidence: 99%

Thinking about health care differently: nurse practitioners in primary health care as social entrepreneurs

Kirkman¹,

Wilkinson

Scahill

2018

J Prim Health Care

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“…NPs are recognized as being ideally placed to deliver care across the biomedical and nursing continuum, working within a social justice paradigm to promote health equity (Browne & Tarlier, 2008; Carryer & Adams, 2017; Poghosyan & Carthon, 2017). The key informants in this study strongly advocated for the development of health services to meet local health need and demonstrated the disconnect between the principles of the Strategy and how it had been enacted locally (King, 2001).…”

Section: Discussionmentioning

confidence: 99%

“…Nurse practitioners (NPs) have the required knowledge and skills to deliver a full complement of PHC services, and there is now a more than adequate body of international evidence, in the form of systematic reviews, to demonstrate the clinical effectiveness and cost-effectiveness of NPs’ work when compared with primary care physicians (Laurant et al., 2018; Martínez-González et al., 2014; Swan et al., 2015). NPs have been proposed as a positive solution to the shortage of medical practitioners, enhancing health services by working within a model of care that bridges biomedicine and nursing, improves access, and reduces health disparities (Browne & Tarlier, 2008; Carryer & Adams, 2017; Contandriopoulos et al., 2016; Grant et al., 2017; Institute of Medicine, 2011; Poghosyan & Carthon, 2017). Their work is underpinned by the core principles of PHC including providing universal access to care, commitment to health equity and social justice, working collaboratively and intersectorally, and working closely with communities (Kooienga & Carryer, 2015; WHO, 1978, 2018).…”

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confidence: 99%

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

Adams

Carryer

2020

Policy, Politics, & Nursing Practice

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The implementation of the nurse practitioner (NP) workforce in primary health care (PHC) in New Zealand has been slow, despite ongoing concerns over persisting health inequalities and a crisis in the primary care physician workforce. This article, as part of a wider institutional ethnography, draws on the experiences of one NP and two NP candidates, as they struggle to establish and deliver PHC services in areas of high need, rural, and Indigenous Māori communities in New Zealand. Using information gathered initially by interview, we develop an analysis of how the institutional and policy context is shaping their experiences and limiting opportunities for the informants to provide meaningful comprehensive PHC. Their work (time and effort), with various health organizations, was halted with little rationale, and seemingly contrary to New Zealand’s strategic direction for PHC stipulated in the Primary Health Care Strategy 2001. The tension between the extant biomedical model, known as primary care, and the broader principles of PHC was evident. Our analysis explored how the perpetuation of the neoliberal health policy environment through a “hands-off” approach from central government and district health boards resulted in a highly fragmented and complex health sector. Ongoing policy and sector perseverance to support privately owned physician-led general practice; a competitive contractual environment; and significant structural health sector changes, all restricted the establishment of NP services. Instead, commitment across the health sector is needed to ensure implementation of the NP workforce as autonomous mainstream providers of comprehensive PHC services.

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“…Where advanced practitioners are fully utilised, they too often cease operating in patient-centred ways and instead take on roles as GP substitutes, ndings supported by New Zealand nursing research [39,40]. Consumers should be involved in designing and implementing advanced practitioner roles so that these roles align with consumer expectations of patient-centred care and continue to operate to their full value [36,41]. In recommending consumer involvement, we recognise that consumer preference will change and therefore, suggest that co-design involve health professionals and consumers in continuous, open dialogue.…”

Section: Discussionmentioning

confidence: 99%

‘She Taught Me’: Factors Consumers Find Important in Nurse Practitioner and Pharmacist Prescriber Services

Officer

Cumming

McBride‐Henry

2020

Preprint

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Background: Advanced practitioner services, such as those nurse practitioners and pharmacist prescribers provide, are an opportunity to improve health care delivery. In New Zealand, these practitioners remain underutilised, despite research suggesting they offer safe and effective care, and considerable international literature recording patient satisfaction with these roles. This study aimed to explore factors underlying consumer satisfaction with primary health care nurse practitioner and pharmacist prescriber services.Methods: As part of a larger realist evaluation, 21 consumers of advanced practitioner services participated in semi-structured interviews. These interviews were transcribed and coded against context-mechanism-outcome configurations tested and refined throughout the research.Results: Study findings emphasise the importance of consumer confidence in the provider as a mechanism for establishing advanced practitioner roles. Underlying this confidence is a recognition that these practitioners are more accessible, engage at the consumer’s ‘level’, and operate with passion.Conclusions: This research offers learnings to re-engineer service delivery within primary health care to make best use of the entire health care team by including consumers in the design and introduction of new roles.

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Nurse practitioners as a solution to transformative and sustainable health services in primary health care: A qualitative exploratory study

Cited by 84 publications

References 37 publications

Thinking about health care differently: nurse practitioners in primary health care as social entrepreneurs

Thinking about health care differently: nurse practitioners in primary health care as social entrepreneurs

How the Institutional and Policy Context Shapes the Establishment of Nurse Practitioner Roles and Practice in New Zealand’s Primary Health Care Sector

‘She Taught Me’: Factors Consumers Find Important in Nurse Practitioner and Pharmacist Prescriber Services

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