Development of collaborative family nurse practitioner education using physician preceptors: A focused critical ethnographic study

Abstract

BackgroundGlobal oppressive power structures in healthcare systems and between professions hinder care delivery. The family nurse practitioner is a new role in Israel. Through an innovative international collaborative education partnership, 19 Israeli nurses were trained as family nurse practitioners. Israeli physician preceptors integrated them into a national health maintenance organization despite national and organizational resistance. ObjectivesExplore Israeli physicians' experiences while providing clinical mentorship to family nurse practitioners and develop strategies for the implementation of the new community role. DesignQualitative focused critical ethnographic approach. ParticipantsEleven Israeli physician preceptors were recruited from a larger pool of 50. MethodsPhysicians were interviewed via recorded phone calls and asked open-ended questions about precepting family nurse practitioners. Observations of the program were included from the year prior to the interviews. Data were analyzed using Carspecken's five steps for critical ethnographic approach. ResultsThree categories for transforming the current status were identified: role clarification, logistics, and collaborative education. Exemplar cases described collaborative practice regarding measurable outcomes. Learning happened through “shadowing” and “coaching” techniques. Findings led to the Collaborative Team Development Illustration which mirrors current recommendations from the World Health Organization and Institute of Medicine. ConclusionsThe Collaborative Team Development Illustration offers a structured strategy for advocacy and transformation in other oppressive health systems considering introducing nurse practitioners. This paper provides evidence that physician participants believed partnerships with nurse practitioners could improve patient care delivery. We hope this research will contribute to changing power relations in healthcare and improve outcomes. This may offer hope for integration of family nurse practitioners in countries that currently do not support advanced practice nursing roles.