Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland

Abstract

Background Internationally many countries have implemented strategies to enhance primary care, to strengthen their health systems to cope with an aging population, the rise of chronic conditions, and increased costs. Primary care has the potential to address these challenges, however, general practitioners are increasingly struggling to meet patient demand resulting from a growing and aging population. Expanding the role of general practice nurses to advanced nurse practitioner (ANP) level has worked internationally and could equally be a solution to the Irish context. However, their current role must first be established as well as their level of interest in becoming an ANP. Aim To explore the role of general practice nurses and their interest in becoming an ANP. Design A survey design. Method A purposeful sample of general practice nurses ( n = 40) was undertaken between April and June 2019. Data were analyzed using the Statistical Package for Social Science (SPSS V 25.0; IBM). Results General practice nurses appear to have an agenda in relation to activities associated with wound care, immunizations, respiratory and cardiovascular issues. Just over half of the respondents were not interested in becoming an ANP. Their perceived challenges associated with the implementation of the role include a lack of support from general practitioners, a lack of resources, insurance issues, and a lack of understanding of the role. Challenges were associated with undertaking further training and their experience of having more work transferred to general practice without concomitant reallocation of resources. Conclusion General practice nurses have extensive clinical experience to deliver major improvements in primary care. Educational opportunities need to be provided for upskilling existing general practice nurses to advanced practice level. Greater understanding of the role and the potential contribution of the role in general practice is required among medical colleagues and the public.

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR

“…Limitations of relevant competences have been previously identified as a barrier to nurses' active involvement in preventive care (Volker et al, 2017). Our experiences are consistent with literature describing the need for ongoing education for upskilling existing nursing profiles to a more advanced level (James et al, 2019;Casey et al, 2022;Morris et al, 2022), especially with regard to patient-centered communication (James et al, 2020b), behavior change theories and counseling, and motivational interviewing; optimizing nurses' effectiveness in communicating about lifestyle risk reduction and the reduction of chronic disease (James et al, 2020a;Hills et al, 2022). Pioneering countries in integrating nurses in general practice, such as the United Kingdom, Australia, and Canada, demonstrate that introducing quality standards, linked with quality performance reimbursement, may support ongoing professionalization, unambiguous articulation of roles and scope, and development of formal educational and career pathways, hereby enabling nurses to practice to their full scope in primary health care teams (Parker et al, 2009;Halcomb et al, 2017).…”

“…Other studies show that nurses play a critical role in broadening, connecting, and coordinating primary and community care (Swanson et al, 2020), by applying competencies such as patient advocacy, education, and people-centered care (World Health Organization, 2020). Recent evidence states that nurses have the extensive clinical experience to deliver major improvements in primary health care (Casey et al, 2022). In various contexts, nurses increasingly and most effectively manage and coordinate care for people with, or at risk of, chronic disease, including tasks related to lifestyle risk counseling (James et al, 2019;Barr & Tsai, 2021).…”

A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia

“…Nurse practitioners are prepared with advanced clinical knowledge, education, skills, and decision-making abilities in complex situations [3]. They are highly qualified and competent healthcare professionals who can act in many settings [4], including primary care and pre-and post-operative care units to provide cost-effective, accessible, patient-centered medical care. As mentioned in the literature [2], the International Council of Nurses defines nurse practitioner as: "A registered nurse who has acquired the expert knowledge base, complex decisionmaking skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice.…”

Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

“…Furthermore, The Lancet (2019) in an editorial describes the inestimable value of nursing and the untapped potential which nursing offers to strengthen primary healthcare services. More recently Casey et al (2022) suggest that general practice nurses provide a valuable resource to general practice particularly in chronic disease management and indeed they may be practicing at an advanced nursing level. Primary healthcare workforce skill mix in six countries, USA, Canada, Australia, England, Germany, and Netherlands was examined by ( Freund et al , 2015 ) who reported nurses as the major non physician workforce in primary care teams.…”

“…Irish GPNs lead and deliver a broad range of the healthcare services, including primary infant and adult immunisation programmes, cervical screening, health promotion and education interventions, disease surveillance, acute and minor illness triage, and management, wound care, and a complex range of generalist nursing services ( Bury et al , 2021 ; Casey et al ., 2022 ; McCarthy et al , 2012 ). Furthermore, GPNs adapted to challenges in delivery of services resulting from the COVID-19 pandemic, and were integral to continuation of services, particularly the delivery of the COVID-19 vaccination programme in general practice ( Homeniuk & Collins, 2021 ; Health Service Executive, 2021 ; Lowry Lehnen, 2021 ).…”