Trust and decision-making: How nurses in Australian general practice negotiate role limitations

Merrick, Eamon; Fry, Margaret; Duffield, Christine; Stasa, Helen

doi:10.1016/j.colegn.2015.03.003

Cited by 6 publications

(5 citation statements)

References 24 publications

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“…A review by McInnes et al [11] and a study by Merrick et al [12] provided worthwhile understandings of challenges to teamwork, collaboration and decision-making in the general practice environment without specifically tackling issues surrounding advanced practice nursing. Other studies focused on nurses performing certain roles [13, 14], working in specific contexts [10, 15], or managing particular illnesses [16–18].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of experiences of advanced practice nursing in general practice

2017

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BackgroundDespite efforts to achieve conceptual clarity, advanced practice nursing continues to reside in a liminal space, unable to secure ongoing recognition as a viable means of healthcare delivery. This is particularly evident in general practice where advanced practice role development is more fluid and generally less supported by the hierarchical structures evident in the hospital system. This review synthesises published qualitative studies reporting experiences of advanced practice nursing in general practice. The panoramic view provided by patients, nurses and doctors within this novel context, offers a fresh perspective on why advanced practice nurses have struggled to gain acceptance within the healthcare milieu.MethodsWe conducted a systematic review of qualitative studies that explored the experiences of patients, nurses and doctors who had contact with advanced practice nurses working in general practice. Published work from 1990 to June 2016 was located using CINAHL and PubMed. The full text of relevant studies was retrieved after reading the title and abstract. Critical appraisal was undertaken and the findings of included studies were analysed using the constant comparative method. Emergent codes were collapsed into sub-themes and themes.ResultsTwenty articles reporting the experiences of 486 participants were included. We identified one major theme: legitimacy; and three sub-themes: (1) establishing and maintaining confidence in the advanced practice nurse, (2) strengthening and weakening boundaries between general practitioners and advanced practice nurses and (3) establishing and maintaining the value of advanced practice nursing.ConclusionsWe set out to describe experiences of advanced practice nursing in general practice. We discovered that general practitioners and patients continue to have concerns around responsibility, trust and accountability. Additionally, advanced practice nurses struggle to negotiate and clarify scopes of practice while general practitioners have trouble justifying the costs associated with advanced practice nursing roles. Therefore, much work remains to establish and maintain the legitimacy of advanced practice nursing in general practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12912-016-0198-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

A systematic review of experiences of advanced practice nursing in general practice

2017

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“…Despite uncertainty and the experience of working in parallel support systems, nurses were loyal to the DSS. A study (Merrick, Fry, Duffield, & Stasa, 2015) identified that nurses take part in the decision-making process regarding patients in healthcare organisations and through this process founded professional relations with staff members and patients. In the reported study, this means that parallel decision-making systems and an uncertainty about decisions made may influence the nurse's role in the decision-making process and their relation to patients and other professionals.…”

Section: Discussionmentioning

confidence: 99%

Decision-makers and mediators in a home healthcare digitisation process: nurses’ experiences of implementation and use of a decision support system

Nilsson

Fagerström

2018

Contemporary Nurse

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Background: This study focuses on a decision support system (DSS) for home healthcare and the implementation of it. Aim: To describe home healthcare nurses' experiences of the implementation and use of a new DSS, with a focus on how it influences decision making in everyday work practice. Design: A qualitative research design. Methods: Data was collected through three focus group interviews with six home healthcare nurses.The data analysis was drawn from Burnard's method for content analysis. Results: The DSS was experienced as bringing support to decisions, but sometimes incompatible with home healthcare nurses' work practice. Professional understanding and the DSS were sometimes experienced as parallel support systems not assisting work across healthcare organisations. Conclusion: When a DSS is used to transform work of healthcare organisations several aspects should be highlighted. If the organisation does not consider these aspects, nurses may adopt a role as mediator in the implementation process.

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“…The role of PHC nurses has been analysed in various health care systems and perspectives, including consumers [13], nursing students [14], and nurses [15]. However, despite the consistent evidence demonstrating positive effect on patient outcomes of RN services in primary care settings, discussion regarding the optimal model of staff mix in PHC centers [16].…”

Section: Introductionmentioning

confidence: 99%

Work activities of primary health care nurses in Poland: National Survey Results

2021

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Background In some countries, including Poland, nurses have acquired autonomy from being a designated “ancillary staff” to “professional staff” only in recent decades. No prior published studies have examined, however, whether the actual nursing practice in primary health care (PHC) has evolved with the advancement of education and professional autonomy. The aim of this study is to assess the scope of practice of a PHC nurses and their actual work activities. Methods A cross-sectional study design using an investigator-developed survey was conducted in Poland, in 2018. The survey was sent to professionally active PHC nurses in Poland. Of the 225 questionnaires distributed, 202 (89.8%) were returned. Results Out of 44 work activities examined, the most often performed activity was administering medications. Less frequent activities included recognizing patients’ nursing needs and health problems and monitoring, assessing, and interpreting basic vital signs. A correlation was found between the length of work experience and the following three activities: performing nursing care, issuing referrals for specific diagnostic tests, and ordering of specific treatments, medications, and nutritional supplements. The longer was the work experience, the more often the nurses performed nursing care (r = 0.15; p = 0.035) but less often issued referrals for diagnostic tests (r = − 0.24; p = 0.001) or orders within their scope of practice (r = − 0.23; p = 0.002). Conclusion While nurses in general are most likely to carry out physician orders, junior nurses tend to be more likely to work toward professional autonomy and pursuing new challenges. PHC nurses in Poland perform work associated more with carrying out physicians’ orders and less with what they were prepared to do. Engaging nursing students in interprofessional education, dissemination of nursing research, and advocacy of nursing professional organizations on behalf of the profession may be an effective strategy to overcome the current barriers for PHC nurses to work the top of their license.

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Trust and decision-making: How nurses in Australian general practice negotiate role limitations

Cited by 6 publications

References 24 publications

A systematic review of experiences of advanced practice nursing in general practice

A systematic review of experiences of advanced practice nursing in general practice

Decision-makers and mediators in a home healthcare digitisation process: nurses’ experiences of implementation and use of a decision support system

Work activities of primary health care nurses in Poland: National Survey Results

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