Advanced practice nurses’ and general practitioners’ first experiences with introducing the advanced practice nurse role to Swiss primary care: a qualitative study

Abstract

BackgroundPrimary care is facing a multimorbid, ageing population and a lack of general practitioners (GPs), especially in rural areas. In many countries, advanced practice nurses (APNs) may be a potential solution for these challenges. Switzerland, however, is in the early stages of APN role development with a handful of pilot projects that are unresearched. Our aim was to explore the experiences of APNs and GPs involved in introducing the APN role to Swiss primary care.MethodsWe organised two focus group discussions with APNs (n = 9) engaged in primary care across German-speaking Switzerland and individual interviews with APNs (n = 2) and GPs (n = 4) from two pilot projects in remote areas. Data analysis followed an exploratory hybrid approach of thematic analysis and was guided by the PEPPA Plus framework.ResultsThe analysis resulted in five main themes: The participants considered themselves pioneers developing a new model in primary care, seeking to shape and improve future health care ((1) pioneering spirit). Both nurses and doctors agreed on the additional value of the APN role, a role seen as having more time for and a different approach to patient care, bringing higher quality of care and flexibility to the practice ((2) added value from the APN role). Participants also emphasized the importance of asking for advice when unsure about diagnostic steps or appropriate treatment ((3) awareness of limited knowledge and skills). The main barriers identified included the impression that Swiss doctors have little knowledge about nurses in advanced roles ((4) GP’s lack of knowledge regarding the APN role), and that further regulations will be important to foster role clarity and accountability ((5) political and legal obstacles in introducing the APN role).ConclusionsThe early phase of introducing APNs to Swiss primary care is characterised by heterogeneous, small-scale projects of pioneering GPs and APNs recognising the added value and limits of APNs despite a lack of governance and knowledge regarding the APN role among GPs. Experiences gained from ongoing projects provide elements of good practice for political discussions and regulations.

Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study

“…Another reason could be that these patients were potentially underserved in this practice, and might have been speci cally assigned to her within the project. In a qualitative study by Gysin et al (14), most NPs who work in Swiss family practices reported a similar patient population they served. (24,25) 22)(14This goes in line with current political efforts to address the increase in chronic conditions.…”

“…Since 2015, educational programs at master's level as well as postgraduate programs have focused more on clinical skills and competencies with the goal to better prepare the students for the NP role. Despite the political interest for new care models in lights of expected GPs shortages in rural areas, there are currently only a handful of ongoing NP pilot projects in primary care with the goal to address the health care needs of the increasing numbers of multimorbid elderly (13,14). One reason for the low number of projects might be that there is no legal framework which de nes the NPs' scope of practice, accountability or reimbursement options (12).…”

Patients’ experiences with the advanced practice nurse role in Swiss family practices: a qualitative study

“…Data was collected from four different family practices in central and north-east Switzerland. These practices were selected because they all engaged an APN as part of a pilot project and were researched in larger evaluations (10,22). The projects varied in their implementation strategy.…”

“…APNs tasks include the initial assessment of needs, routine follow-up care and advising patients on self-care management or life changes (3,8,9). In addition, several studies have shown that APNs, regardless of the eld of implementation (hospitals, general practice or hospital at home models) are likely to achieve higher patient satisfaction than GPs, due to longer consultations, the comprehensive provision of health information and advice, as well as their psychosocial (patient-centered) communication style (3,6,(10)(11)(12)(13). Furthermore, Jakimowicz (14) found in their review, that patients appreciated the involvement of APNs in their treatment because they displayed a focus on the patient as a person with additional concerns and not just on the disease.…”

“…Even though studies about APNs in Switzerland are limited, there is the so-called PEPPA Plus framework by Bryant-Lukosius et al (25) for evaluating the impact of the different APN roles. Based on this framework, Gysin et al (10) explored APNs' and GPs' rst experiences with introducing the APN role into Swiss family practices. They found that both APNs and GPs agreed on the added value of the APN and highlighted the importance of raising awareness among GPs and implementing suitable regulations to ensure the long-term sustainability of the APN role.…”