Advanced nurse practitioners and GPs: what is the difference?

Abstract

In primary care, a crossover of role boundaries between GPs and advanced nurse practitioners (ANPs) has led to a lack of role definition. This article analyses the findings from a study that attempted to define the distinctiveness of the ANP and GP roles. Two ANPs and two GPs from a training practice took part in the study. Consultations were recorded, transcribed and analysed using a qualitative methodology. Patient conversations were divided into six phases of the consultation: opening; history-taking; physical examination; diagnosis; management; and closing. Practitioner–patient interactions and behaviour were examined in each of the phases. Two typical extracts are highlighted: one between a GP and patient, and the other between an ANP and patient. ANPs interwove expert nursing skills throughout each interview, making their nursing identity clearly visible to patients. This study identified that GPs work in a different style to that of nurses, with ANPs working to diminish social distance from patients rather than creating it; this positions ANPs more in line with nursing than with medicine.

Professional identity of Korean nurse practitioners in the United States

“…Other study results also support that NPs try to diminish the social distance between themselves and patients with more frequent interaction and conversation (Paniagua, 2011).…”

“…Another study proved that physicians mostly focus on physical problems while nurses have broader and more comprehensive opinions and are interested in patients’ ability to handle everyday life (Piil et al., ). Other study results also support that NPs try to diminish the social distance between themselves and patients with more frequent interaction and conversation (Paniagua, ).…”

Collaborative communication: learning from advanced clinical practice patient consultations

“…when ANPs adopt a hybrid style of communication, combining discussion of objective biomedical information with subjective information from everyday life (Barratt 2005, Paniagua 2011). This hybrid approach may include 'exploring the patient's illness experience and the disease, understanding the whole person, finding common ground, incorporating health promotion and prevention, enhancing the participants' relationship and using resources realistically' (Pawlikowska et al 2012), which in turn may enhance patient outcomes such as patient satisfaction, ability to self-manage healthcare needs and adherence to care plans (Agosta 2009, Pawlikowska et al 2012.…”

“…Integrated clinical reasoning can also be used by ANPs to verbalise their cognitive clinical reasoning to patients and carers by, for example, thinking out loud (Paniagua 2011) or discussing clinical uncertainties with patients (Brykczynski 1989). In this way, clinical reasoning can be used during consultations to improve the patient's understanding of the challenges involved in establishing differential diagnoses and, in particular, that diagnoses can alter and may not be definitive.…”

Obvladovanje dejavnikov tveganja za nastanek srčno-žilnih bolezni v referenčni ambulanti družinske medicine

“…V primerjalni raziskavi o delu zdravnika in delu diplomirane medicinske sestre pri prvem stiku in svetovanju pacientu Paniagua (2011) ugotavlja, da so se pacienti v vseh stopnjah prvega srečanja in posvetovanja na diplomirano medicinsko sestro pozitivno odzvali. Pacienti so bolj kot pri zdravniku sodelovali v pogovoru in izražali svoja mnenja, pri sami obravnavi so bili tudi bolj sproščeni (Paniagua, 2011). V raziskavi, ki jo je izvedla Organizacija za gospodarsko sodelovanje in razvoj (Organisation for Economic Co-operation and Development -OECD), ugotavljajo, da imajo pri izboljšanju zagotavljanja zdravstvenih storitev ključno vlogo prav medicinske sestre (Delamaire & Lafortune, 2010).…”