Nurse practitioner integration: Conceptual development to enhance application in policy and research

Abstract

Background: Nurse practitioners (NPs) have been introduced across the world to improve care quality and solve provider shortages. Realizing these benefits relies on their successful integration into health care systems. Although NP integration has been discussed extensively, the concept is defined inconsistently. Literature, therefore, cannot be synthesized to create policy recommendations for management and policymakers to plan for and advance NP integration.Objectives: To describe and define NP integration and enhance its applicability in research and policy.Data Sources: A modified Walker and Avant concept analysis was used to develop a conceptual model of NP integration. Data were extracted and synthesized from 78 sources referencing the concept.Conclusions: Nurse practitioner integration was operationally defined as the multilevel process of incorporating NPs into the health care system so that NPs can practice to their full scope, education, and training and contribute to patient, system, and population needs. The attributes of NP integration are: 1) achievable goal; 2) process; 3) introduction of the role; 4) incorporation into organizational care models; 5) challenging traditional ideologies; 6) ability to function; 7) provide highquality care; and 8) improve outcomes, sustainability, and health system transformation. Seventeen facilitators/barriers affecting NP integration were identified. Three health care system levels at which integration occurs were identified-macro, meso, and micro.

Understanding factors affecting the integration of geriatric nurse practitioners into health systems

“…National leaders from other health professions should be consulted and express cooperation (engaging) (Bryant-Lukosius et al, 2004). Beginning the integration process without such understanding can result in poor integration progress and wasted resources because policies must be retrospectively updated and often with opposition in practice (execution) (Porat-Dahlerbruch et al, 2022;Porat-Dahlerbruch et al, 2023).…”

“…No research has systematically evaluated the full range of factors influencing efficacious geriatric NP integration in Israel on a national scale. Without such information, national and organizational policymakers lack sufficient, evidence-based information to design policies that can magnify facilitators and curtail barriers to geriatric NP integration (Porat-Dahlerbruch et al, 2022;Porat-Dahlerbruch et al, 2023). This study intends to address this knowledge gap by identifying factors affecting the integration of geriatric NPs in Israel.…”

“…Internationally, little is known about the process of integrating geriatric NPs into health systems (Torrens et al, 2020). Nurse practitioner integration can be defined as "a multilevel process of incorporating NPs into the health system to an extent at which they can function to the full extent of their education, training, and scope of practice and contribute to patient, health system, and population needs" (Porat-Dahlerbruch et al, 2022). To achieve intended patient, system, and workforce outcomes, NPs must successfully integrate into all levels of the health system-national, organizational, and care team levels (Porat-Dahlerbruch et al, 2022;Porat-Dahlerbruch et al, 2023).…”

“…Nurse practitioner integration can be defined as "a multilevel process of incorporating NPs into the health system to an extent at which they can function to the full extent of their education, training, and scope of practice and contribute to patient, health system, and population needs" (Porat-Dahlerbruch et al, 2022). To achieve intended patient, system, and workforce outcomes, NPs must successfully integrate into all levels of the health system-national, organizational, and care team levels (Porat-Dahlerbruch et al, 2022;Porat-Dahlerbruch et al, 2023). Due to a dearth in the knowledge, policymakers and organizational leaders lack sufficient evidence to ensure that policies are designed to promote the maximal contribution of geriatric NPs in practice (Henni et al, 2019).…”

Promoting ENP Research

“…A: Recent articles by Porat-Dahlerbruch, Poghosyan, Blumenthal, Ratz, and Ellen (2022), Davis, Evans, Fiebig, and Lewis (2020), and Cuccovia, Heelan-Fancher, and Aronowitz (2021) provide unique conceptual frameworks for examining ENP scope of practice and emergency care practice that can provide a foundation for examining nurse practitioner policy and research questions.…”