Shifting Patterns of Practice: Nurse Practitioners in a Managed Care Environment

Exploring Factors that May Influence Ontario Nurse Practitioners’ Patient Panel Size in Primary Healthcare Settings

“…This factor included years of experience working as a NP, as well as years of experience a NP had been working in a particular PHC setting; each impacted how quickly patients were assessed and how many patients a NP saw per day. Several international studies identified that the outcomes of patients cared for by novice/beginner NPs with one to five years of experience were similar to those of patients seen by family physicians (Dierick-van Daele et al, 2009;Dierick-van Daele, Steuten, Romeijn, Derckx, and Vrijhoef, 2011;Johnson, 2005;Venning, Durie, Roland, Roberts, & Leese, 2000). Novice NPs, however, were more likely to ask the patient to return for a follow-up visit and took more time doing consultations.…”

“…Venning et al (2000) found that NPs reported spending a mean of 1.33 minutes per patient waiting for a prescription signature from the family physician, which resulted in wasted time and fragmented care. Johnson (2005) found that NP autonomy often depended on the type of care environment in which a NP works: NPs in specialty practices were viewed as an added value, whereas NPs in PHC practices were often viewed as a substitute for a physician. Dierick van Daele et al (2009Daele et al ( , 2011 and Liu and D'Aunno (2012) found that when a NP in PHC assumed a substitution role for a physician, they were able to replace 70-80% of physician activities.…”

“…Based on the evidence from the literature it was hypothesized that novice NPs (less than five years of experience) were likely assigned smaller patient panel sizes due to inexperience in their role (Dierick-van Daele et al, 2009;Dierick-van Daele et al, 2011;Johnson, 2005;Venning et al, 2000;VHA, 2009). However, no relationship was found between years of experience (in total or in current practice setting) and NP patient panel size in the present study.…”