Advanced practice nurses in primary care in Switzerland: an analysis of interprofessional collaboration

Renata Josi,Monica Bianchi,Sophie Karoline Brandt

doi:10.1186/s12912-019-0393-4

Abstract

BackgroundThe increase in the number of chronically ill patients due to ageing is calling existing models of primary care (PC) into question. New care models have recently been implemented in Swiss PC and involve interprofessional teams. This paper aimed to investigate the practice of interprofessional collaboration between advanced practice nurses, registered nurses, and medical practice assistants within new models of PC in Switzerland using the National Interprofessional Competency Framework.MethodsAn ethnographic design comprising semi-structured interviews and non-participant observations was conducted. Sixteen interviews were conducted with care providers at their PC practice. Interviewees included four advanced practice nurses, two registered nurses, six medical practice assistants, and four general practitioners. Nine other health professionals were subsequently observed in their practice. Interviews and observations were conducted by the first author from February to April 2019.ResultsOur analysis of interview and observational data confirmed that role clarification, team functioning, collaborative leadership, interprofessional conflict resolution, patient-centered care, and interprofessional communication have a significant influence on the interprofessional collaboration among health professionals in Swiss PC. Among these domains, role clarification and team functioning were the most frequently raised issues. Both were found to have the potential to negatively influence and, therefore, hinder efficient interprofessional collaboration within PC.ConclusionFrom the analysis, it emerged that role clarification is crucial for effective interprofessional collaboration within new care delivery models in the Swiss PC context. Our study results may inform international health policymakers and practitioners about six important domains of interprofessional care when implementing new care models. Practical experience with new models of care involving advanced practice nurses and medical practice assistants may also influence the regulation of the scope of practice of these health professionals in Switzerland.

Highlights

For various reasons, including the increasing number of chronically ill patients and significant advances in medicine in recent times, through which patients are living longer and longer, the demand for primary care (PC) and community care services is on the rise
From the analysis, it emerged that role clarification is crucial for effective interprofessional collaboration within new care delivery models in the Swiss primary care context
Practical experience with new models of care involving advanced practice nurses and medical practice assistants may influence the regulation of the scope of practice of these health professionals in Switzerland

Summary

Introduction

For various reasons, including the increasing number of chronically ill patients and significant advances in medicine in recent times, through which patients are living longer and longer, the demand for primary care (PC) and community care services is on the rise. Patients’ needs are becoming more complex with an increase in multi-morbidity rates This situation calls into question today’s care delivery models. Recently have some APNs and medical practice assistants (MPA) started to work in primary care practices (PCPs) who have implemented new models of care. Those care models involve interprofessional teams where health professionals adopt new roles and tasks. This article aims to analyze the practice of interprofessional collaboration within new models of care involving APNs, nurses without APN education, and MPAs in Swiss PC using an established international framework. New care models have recently been implemented in Swiss primary care and involve interprofessional teams. The shortage of GPs today predominantly affects rural areas in Switzerland, where people already encounter difficulties locating a GP in their area

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