Integration Of Nurse Practitioners Research Articles

Nurse Practitioner Integration: Insights Into the Next Generation of Policy and Research.

Nurse Practitioner Integration: Insights Into the Next Generation of Policy and Research.

Nurse practitioner integration: Conceptual development to enhance application in policy and research.

Nurse practitioners (NPs) have been introduced across the world to improve care quality and solve provider shortages. Realizing these benefits relies on their successful integration into health care systems. Although NP integration has been discussed extensively, the concept is defined inconsistently. Literature, therefore, cannot be synthesized to create policy recommendations for management and policymakers to plan for and advance NP integration. To describe and define NP integration and enhance its applicability in research and policy. A modified Walker and Avant concept analysis was used to develop a conceptual model of NP integration. Data were extracted and synthesized from 78 sources referencing the concept. Nurse practitioner integration was operationally defined as the multilevel process of incorporating NPs into the health care system so that NPs can practice to their full scope, education, and training and contribute to patient, system, and population needs. The attributes of NP integration are: 1) achievable goal; 2) process; 3) introduction of the role; 4) incorporation into organizational care models; 5) challenging traditional ideologies; 6) ability to function; 7) provide high-quality care; and 8) improve outcomes, sustainability, and health system transformation. Seventeen facilitators/barriers affecting NP integration were identified. Three health care system levels at which integration occurs were identified- macro , meso , and micro . Findings will inform managers, policymakers, and stakeholders about NP integration to aid in planning and policy development. Results can be used to inform research on barriers and facilitators to NP integration.

Enacting primary healthcare interprofessional collaboration: a multisite ethnography of nurse practitioner integration in Ontario, Canada

ABSTRACT Interprofessional collaboration (IPC) is known to enhance patient outcomes and satisfaction. In primary healthcare (PHC), IPC aims to transform care provision and team functioning, but its implementation is challenging and has yielded mixed results. We aimed to describe the enactment of IPC in PHC settings, particularly as it relates to nurse practitioner (NP) integration. A multisite ethnography involving 6 Canadian PHC clinics was carried out. We conducted 330 hours of direct observation, 23 semi-structured interviews with PHC NPs, informal interviews with key PHC partners, and document analysis. IPC in PHC was found to rest on human and non-human actors that interact in complex ways. Organizational mandates and remuneration models, physical spaces and schedules played a decisive role in the enactment of IPC. Power structures embedded in certain designations (i.e., most responsible provider) or NPs’ commitments to physicians’ practices stood in contrast with the principles of IPC. NPs enacted various role to develop, enhance, and maintain IPC. Despite shifts in PHC provision, IPC remains poorly defined and precariously sustained.

A survey of nurse practitioner perceptions of integration into acute care organisations across one region in Ireland.

AimThe purpose of the study was to explore nurse practitioner perceptions of integration practices in acute hospitals across one health care region in Ireland.BackgroundA recent Department of Health National policy towards developing a critical mass of nurse practitioners was implemented across Ireland. Successful integration of nurse practitioner roles is integral to the success of the service and sustainability of the roles for the long term.MethodAn electronic survey was circulated to a convenience sample of 85 nurse practitioners across a single, acute health care region in Ireland.ResultsSixty‐six (78%) of nurse practitioners participated. A standardized governance structure was reported by 24 (36%) participants. Thirty‐two (48%) participants expressed their job description clearly defined their role. Consultant physicians were identified as the most supportive stakeholder by participants.ConclusionsThis research identifies that nurse practitioner integration is not currently structured. A framework to support nurse practitioner integration is required to ensure ongoing support for the role. This research identifies that integration is not currently optimized.Implications for Nursing ManagementFailure to successfully integrate the nurse practitioner role risks the long‐term sustainability of the role and is a missed opportunity to demonstrate the success of advanced clinical leadership to health care.

Nurse practitioner integration: Qualitative experiences of the change management process.

The aim of this qualitative research was to explore perceptions of organisational change related to the integration of nurse practitioners from key nursing stakeholders. The ongoing delivery of effective and efficient patient services is reliant upon the development and sustainability of nurse practitioner roles. Examination of the factors contributing to the underutilization of nurse practitioner roles is crucial to inform future management policies. A change management theory is used to reveal the complexity involved. Qualitative interviews were undertaken using a purposive sampling strategy of key stakeholders. Thematic analysis was undertaken and key themes were correlated to the theoretical framework. The results confirm the benefits of nurse practitioner roles, but suggest organisational structures and embedded professional cultures present barriers to full role optimization. Complicated policy processes are creating barriers to the integration of nurse practitioner roles. The findings increase understanding of the links between strategic planning, human resource management, professional and organisational cultures, governance and politics in change management. Effective leadership drives the change process through the ability to align key components necessary for success. Sustainability of nurse practitioners relies on recognition of their full potential in the health care team. The results of this study highlight the importance of management and leadership in the promotion of advanced nursing skills and experience to better meet patient outcomes. The findings reinforce the potential of nurse practitioners to deliver patient centred, timely and efficient health care.

Supporting nurse practitioners\u2019 practice in primary healthcare settings: a three-level qualitative model

BackgroundWhile greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners’ integration. This study’s main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner’s practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices.MethodsThis study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches.ResultsThis article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels.ConclusionsBased on these findings, we suggest that support practices should be adapted to each organization’s environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.

Using Dialogic Methods as a Participatory Knowledge Translation Approach to Promote Integration of Nurse Practitioners in Primary Healthcare Settings.

Background: Nurse practitioners (NPs) were introduced in British Columbia (BC) in 2005 as a new category of health provider. Given the newness of NPs in our health system, it is not unexpected that continued work is required to better integrate NPs in healthcare in BC. Aim: This paper will focus on a research study using dialogic methods as a participatory knowledge translation approach to facilitate integration of NPs in primary healthcare (PHC) settings. Methods: Deliberative dialogue (DD) is a useful knowledge translation tool in health services delivery. Through facilitated conversations with stakeholders, invited to consider research evidence in the context of their experience and tacit knowledge, collective data are generated. DD is a powerful tool to engage stakeholders in the development and implementation of evidence-informed policies and services through discussion of issues, consideration of priorities and development of concrete actions that can be implemented by policy makers and decision-makers. Two DD sessions were held with stakeholders involved in supporting NP integration in a health authority in southern interior BC. Stakeholders were provided syntheses of a literature review and interview results. The first session resulted in the collective development of 10 actions to promote NP integration in PHC settings. The second session was conducted six months later to discuss progress and revisions to actions. Discussion: The use of the dialogic methods used in studying NP integration in PHC settings proved useful in promoting real conversation about the implications of research evidence in living contexts, enabling diverse stakeholders to co-create collaborative actions for further NP integration. The conversations and actions were used to support further NP integration during the study and beyond. Conclusion: DD is a useful approach for transforming health services policy and delivery. It has the potential to move change forward with co-created solutions by the stakeholders involved.

Using a mixed-methods design to examine nurse practitioner integration in British Columbia.

To discuss and provide examples of how mixed-methods research was used to evaluate the integration of nurse practitioners (NPs) into a Canadian province. Legislation enabling NPs to practise in British Columbia (BC) was enacted in 2005. This research evaluated the integration of NPs and their effect on the BC healthcare system. Data were collected using surveys, focus groups, participant interviews and case studies over three years. Data sources and methods were triangulated to determine how the findings addressed the research questions. The challenges and benefits of using the multiphase design are highlighted in the paper. The multiphase mixed-methods research design was selected because of its applicability to evaluation research. The design proved to be robust and flexible in answering research questions. As sub-studies within the multiphase design are often published separately, it can be difficult for researchers to find examples. This paper highlights ways that a multiphase mixed-methods design can be conducted for researchers unfamiliar with the process.

A process-based framework to guide nurse practitioners integration into primary healthcare teams: results from a logic analysis.

BackgroundIntegrating Nurse Practitioners into primary care teams is a process that involves significant challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- professional collaboration, and team-based work processes that make the best use of the subsidiarity principle. There have been numerous studies on nurse practitioner integration, and the literature provides a comprehensive list of barriers to, and facilitators of, integration. However, this literature is much less prolific in discussing the operational level implications of those barriers and facilitators and in offering practical recommendations.MethodsIn the context of a large-scale research project on the introduction of nurse practitioners in Quebec (Canada) we relied on a logic-analysis approach based, on the one hand on a realist review of the literature and, on the other hand, on qualitative case-studies in 6 primary healthcare teams in rural and urban area of Quebec.ResultsFive core themes that need to be taken into account when integrating nurse practitioners into primary care teams were identified. Those themes are: planning, role definition, practice model, collaboration, and team support.The present paper has two objectives: to present the methods used to develop the themes, and to discuss an integrative model of nurse practitioner integration support centered around these themes.ConclusionIt concludes with a discussion of how this framework contributes to existing knowledge and some ideas for future avenues of study.

Role clarification processes for better integration of nurse practitioners into primary healthcare teams: a multiple-case study.

Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.

Integration of Nurse Practitioners and Physician Assistants in Emergency Departments

Integration of Nurse Practitioners and Physician Assistants in Emergency Departments

‘Crossing Professional Boundaries’: Barriers to the Integration of Nurse Practitioners in Primary Care

WHAT IS ALREADY KNOWN IN THIS AREA • Nurse practitioners have been introduced to primary care as part of current policy reforms to improve delivery and quality of care. • The role of nurse practitioner in the UK is not defined and not yet recognised or registered by the Nursing and Midwifery Council. WHAT THIS WORK ADDS • There are both practical and cultural barriers to the integration of the nurse practitioner role in primary care. • To facilitate the integration of the nurse practitioner role, both practical and cultural issues around crossing professional boundaries need to be addressed. SUGGESTIONS FOR FUTURE RESEARCH • Further research into the barriers to the integration of nurse practitioners in primary care and into possible solutions to the barriers in the context of ongoing policy changes. • Comparative studies in other parts of the UK and perhaps with other healthcare models in the world.