Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Brault, Isabelle; Kilpatrick, Kelley; D’Amour, Danielle; Contandriopoulos, Damien; Chouinard, Véronique; Dubois, Carl-Ardy; Perroux, Mélanie; Beaulieu, Marie-Dominique

doi:10.1155/2014/170514

Cited by 71 publications

(72 citation statements)

References 20 publications

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“…A significant finding is that, although RNs, LPNs and HCAs work interdependently, they did not know what each other's roles entailed. Our findings add to the nursing team literature by revealing that nursing teams composed of various roles have difficulties in understanding one another's roles (Brault et al., ; Hewko et al., ; Lankshear & Rush, ). Some of this role confusion could be explained by the overlap in the LPNs and RNs roles, also evident in practice legislation.…”

Section: Discussionsupporting

confidence: 55%

Nursing care providers’ perceptions on their role contributions in patient care: An integrative review

Kusi-Appiah

Dahlke

Wall

2018

Journal of Clinical Nursing

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Section: Discussionsupporting

confidence: 55%

Nursing care providers’ perceptions on their role contributions in patient care: An integrative review

Kusi-Appiah

Dahlke

Wall

2018

Journal of Clinical Nursing

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“…However, the authors also called for changes in political and economic structures, including common training involving interdisciplinary collaboration, to improve collaboration between physicians. Also elsewhere in the health care sector, clear roles have been found essential for effective multidisciplinary collaboration [29], which agrees with the current findings.…”

Section: Discussionsupporting

confidence: 91%

Collaboration between employers and occupational health service providers: a systematic review of key characteristics

et al. 2017

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BackgroundEmployees are major contributors to economic development, and occupational health services (OHS) can have an important role in supporting their health. Key to this is collaboration between employers and OHS. We reviewed the evidence regarding the characteristics of good collaboration between employers and OHS providers that is essential to construct more effective collaboration and services.MethodsA systematic review of the factors of good collaboration between employers and OHS providers was conducted. We searched five databases between January 2000 and March 2016 and back referenced included articles. Two reviewers evaluated 639 titles, 63 abstracts and 20 full articles, and agreed that six articles, all on qualitative studies, met the predetermined relevance and publication criteria and were included. Data were extracted by one reviewer and checked by a second reviewer and analysed using thematic analysis.ResultsThree themes and nine subthemes related to good collaboration were identified. The first theme included time, space and contract requirements for effective collaboration with three subthemes (i.e., key characteristics): flexible OHS/flexible contracts including tailor-made services accounting for the needs of the employer, geographical proximity of the stakeholders allowing easy access to services, and long-term contracts as collaboration develops over time. The second theme was related to characteristics of the dialogue in effective collaboration that consisted of shared goals, reciprocity, frequent contact and trust. According to the third theme the definition of roles of the stakeholders was important; OHS providers should have competence and knowledge about the workplace, become strategic partners with the employers as well as provide quality services.ConclusionAlthough literature regarding collaboration between the employers and OHS providers was limited, we identified several key factors that contribute to effective collaboration. This information is useful in developing indicators of effective collaboration that will enable organisation of more effective OHS practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-3924-x) contains supplementary material, which is available to authorized users.

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“…23 The setting size and space often influence the type of communication used, with smaller settings using more informal modes of communication, such as text messages. 30 Comanagement communication must be performed in a timely manner that is dependent on the patient needs, such as a change in patient acuity level. The communication needs to be reciprocal with equal sharing of ideas, new patient information, and feedback necessary to improve quality of care.…”

Section: Effective Communicationmentioning

confidence: 99%

Section: Mutual Respect and Trustmentioning

confidence: 99%

“…This attribute increases over time as physicians and nurse practitioners work together longer 32 ; developing reciprocal trust and respect of each other's role in care delivery can take up to 6 months. 30 By gaining trust, physicians are less likely to feel that they need to supervise or "double-check" the work of the nurse practitioner, thereby reducing redundancy of documentation and diagnostic testing.Traditionally, some physicians view nurse practitioners as having an inferior role in primary care. This viewpoint inhibits nurse practitioners from working to their full potential and can create mistrust or resentment.…”

mentioning

confidence: 99%

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Nurse Practitioner–Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain

Norful

Jacq

Carlino³

et al. 2018

Ann Fam Med

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PURPOSE Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. METHODSWe conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. RESULTSOur model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/ shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians.CONCLUSIONS Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. Ann Fam Med 2018;16:250-256. https://doi.org/10.1370/afm.2230. INTRODUCTIONW ith imminent staffing shortages in the health care profession and an increase in the volume of patients seeking primary care services, patient loads are increasing rapidly, thus making it difficult for a single primary care professional to manage all patient care needs effectively and efficiently.1-4 Therefore, policy makers are calling for new primary care delivery models to meet the increased demands for care, especially due to patients with multiple comorbidities requiring more complex primary care visits. Different models of care delivery have been proposed, including team-based care, yet these models often have variability in task allocation and professional roles.5 Identifying innovative models of care delivery is increasingly important to meet these demands in primary care.One proposed care delivery model includes having more than 1 primary care professional comanaging the same patient and sharing the workload responsibilities or care management tasks. Researchers have explored comanagement of patients by 2 physicians in primary care, 6 and by a physician and a nonphysician ...

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Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Cited by 71 publications

References 20 publications

Nursing care providers’ perceptions on their role contributions in patient care: An integrative review

Nursing care providers’ perceptions on their role contributions in patient care: An integrative review

Collaboration between employers and occupational health service providers: a systematic review of key characteristics

Nurse Practitioner–Physician Comanagement: A Theoretical Model to Alleviate Primary Care Strain

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