Abstract
BackgroundPrimary care is facing a multimorbid, ageing population and a lack of general practitioners (GPs), especially in rural areas. In many countries, advanced practice nurses (APNs) may be a potential solution for these challenges. Switzerland, however, is in the early stages of APN role development with a handful of pilot projects that are unresearched. Our aim was to explore the experiences of APNs and GPs involved in introducing the APN role to Swiss primary care.MethodsWe organised two focus group discussions with APNs (n = 9) engaged in primary care across German-speaking Switzerland and individual interviews with APNs (n = 2) and GPs (n = 4) from two pilot projects in remote areas. Data analysis followed an exploratory hybrid approach of thematic analysis and was guided by the PEPPA Plus framework.ResultsThe analysis resulted in five main themes: The participants considered themselves pioneers developing a new model in primary care, seeking to shape and improve future health care ((1) pioneering spirit). Both nurses and doctors agreed on the additional value of the APN role, a role seen as having more time for and a different approach to patient care, bringing higher quality of care and flexibility to the practice ((2) added value from the APN role). Participants also emphasized the importance of asking for advice when unsure about diagnostic steps or appropriate treatment ((3) awareness of limited knowledge and skills). The main barriers identified included the impression that Swiss doctors have little knowledge about nurses in advanced roles ((4) GP’s lack of knowledge regarding the APN role), and that further regulations will be important to foster role clarity and accountability ((5) political and legal obstacles in introducing the APN role).ConclusionsThe early phase of introducing APNs to Swiss primary care is characterised by heterogeneous, small-scale projects of pioneering GPs and APNs recognising the added value and limits of APNs despite a lack of governance and knowledge regarding the APN role among GPs. Experiences gained from ongoing projects provide elements of good practice for political discussions and regulations.
Highlights
Primary care is facing a multimorbid, ageing population and a lack of general practitioners (GPs), especially in rural areas
The analyses of the interviews and focus group discussions illustrate how theoretical concepts of the PEPPA Plus framework are experienced in practice and resulted in five main themes: (1) “Pioneering spirit”, (2) “Added value from the Advanced Practice Nurse (APN) role”, (3) “Awareness of limited knowledge and skills”, (4) “GP’s lack of knowledge regarding the APN role” and (5) “Political and legal obstacles in introducing the APN role”
Pioneering spirit All nurses felt like pioneers with the opportunity to help develop and shape the role of APNs in Swiss primary care
Summary
Primary care is facing a multimorbid, ageing population and a lack of general practitioners (GPs), especially in rural areas. In many countries, advanced practice nurses (APNs) may be a potential solution for these challenges. General practitioners (GPs) are scarce, especially in rural areas [3, 4]. To counteract these challenges, primary care is being reinvented, and many countries have introduced and developed the role of advanced practice nurses (APNs) [5]. The most common roles for APNs are the clinical nurse specialist (CNS) with in-depth expertise in a specialised area of practice (e.g. oncology), and the nurse practitioner (NP), with an expanded scope of practice in diagnosing, prescribing, treating, and referring patients [8]
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