New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning

Abstract

BackgroundOptimising health professionals’ contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada).MethodsWe used Giddens’ structuration theory to guide our study given its’ facilitation of the understanding of the dynamic between structural constraints and actors’ actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016–2017.ResultsForty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others’ inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs’ sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity).ConclusionSeveral new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.

Perception of the implementation of the nurse practitioner role in a Norwegian out-of-hours primary clinic: An email survey among healthcare professionals and patients

“…This is in accordance with previous studies which show that shifting tasks from physicians to NPs is challenging and often met with skepticism. 8,29,30 In addition, to successfully shift tasks, it is essential to have knowledge about NPs' competence before implementing the new role. 8,[30][31][32] Other findings from previous studies also showed that when GPs had experience working with an NP they had a more positive view of task shifting.…”

Barriers and facilitators to the implementation of nurse's role in primary care settings: an integrative review

“…We screened 18257 records and considered 283 full texts for inclusion in this integrative review. Fifty-six papers met the inclusion criteria (20,21,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)22,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)23,(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)24,(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)25,(70)(71)(72)(73)(74)…”

“…Studies were conducted across thirteen countries: nine studies in Oceania (26,32,35,44,60,66,(68)(69)(70), one in Asia ( 36), twenty-one in Europe (20,21,(51)(52)(53)(54)57,58,62,65,67,73,22,74,29,33,34,(41)(42)(43)46), twenty-four in North America (23,24,40,45,(47)(48)(49)(50)55,56,59,61,25,64,71,72,75,27,28,30,…”

“…Studies included nurse's role referred to nurse practitioner working in advanced role (21,23,(37)(38)(39)(40)(41)(42)(44)(45)(46)(47)24,(48)(49)(50)(51)(52)(53)(54)(55)(56)59,26,(61)(62)(63)(64)(66)(67)(68)(69)72,74,27,75,(28)(29)(30)(31)35) and registered nurse working in advanced practice level or with specialist designation (20,22,60,65,70,71,73,25,32,…”

“…Restrictions of nurse scope of practice and autonomy was the most frequently reported barrier to the nurse's role implementation (21,23,53,55,56,24,28,31,35,44,45,47,48). Arbitrary laws (31), state restriction, hospital regulations (28), and health care professionals' expectations (35,55) contributed to restricted nurses' independence and the full potential of the role. For instance, regulations require that nurses be supervised by physicians when exercising their prescriptive authority (38)(39)(40).…”