Nurse practitioner integration: Qualitative experiences of the change management process (original) (raw)
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Integration of nurse practitioners using a change management framework: the way forward
Australian Health Review, 2016
Objective The aim of the present study was to investigate and describe the application of a change management theoretical framework in relation to nurse practitioner (NP) role integration. Methods A survey formed Phase 1 of a broader mixed-methods study to explore perceptions of the change process involved with integrating NPs into Australian health care settings. The stakeholder participants were NPs, nurse managers and nurse policy advisers. Results Key themes were identified adding information about how NPs, nurse managers and nurse policy advisers perceive the integration of NPs into Australian healthcare. The themes correlate to the components of organisational change management necessary to embed NPs into the healthcare workforce. Conclusions Healthcare reform is a complex organisational change. Alignment of several key elements is required for the process to be successful. A change management proposal for reframing organisations provides an apt framework for use in the Austra...
Role Development of Nurse Managers in The Changing Health Care Practice
2018
Rapid changes in today’s healthcare industry are reshaping nurses’ role. The emergence of new healthcare system, the shift from service to business orientations, and extensive redesign of workplace affects the where and how nursing care is delivered as well as those who delivered the care. In the Philippines, healthcare system is in the midst of dramatic evolvement- the devolution of hospitals to LGUs, free healthcare for senior citizens and no balance billing policy yielding to increased client-nurse ratio. These impacts change the roles of nurse managers and their practice. The study aimed to understand the experience and phenomena of nurse managers, their roles in the dynamics of healthcare practice, and seek ways to enhance the development of these roles. The study used descriptive phenomenology-qualitative design, and utilized Colaizzi method during data analyses. Through researcher-made guide questions, the study employed purposively nurse managers as key informants from terti...
How case-study research can help to explain implementation of the nurse practitioner role
Nurse Researcher, 2013
Background: At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members' acceptance for the new role. Method: The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents.
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. Isabelle Brault, Kelley Kilpatrick, Danielle D’Amour, Damien Contandriopoulos, Véronique Chouinard, Carl-Ardy Dubois, Mélanie Perroux, and Marie-Dominique Beaulieu.
Background: While 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. Methods: This 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.
BMC Health Services Research, 2019
BackgroundOptimising health professionals’ contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada).MethodsWe used Giddens’ structuration theory to guide our study given its’ facilitation of the understanding of the dynamic between structural constraints and actors’ actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016–2017.ResultsForty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others’ inadequa...
Nurses Perception of Advance Nurse Practitioners Roles in Public Hospitals: A Qualitative Study
Open Journal of Nursing
Aim: To explore the nurses' perceptions about the advanced nurses' practitioner's role in public hospitals in Saudi Arabia. Background: Advanced nurse practitioners are one of the leading professionals who contribute to health promotion, disease prevention, health counseling and patient education. However, misunderstandings of their roles may have an impact on the performances of the function that limits their access and the use of significant resources that can help patients to obtain treatment. Methods: This is a qualitative exploratory study conducted on nurses working in three public hospitals. Semi-structured interviews were conducted among fourteen nurses between October-January 2020. The three public hospitals were based in Eastern (1) and Central (2) Saudi Arabia regions. Data analysis was conducted through thematic analysis utilizing inductive and deductive coding. Results: The study found that the role of Advanced Practice Nurses will enhance, motivate, and sustain the status of nurses in Saudi Arabia. Findings indicated that advanced practitioners' educational preparedness, organizational, and contextual factors are important factors that need to be addressed to promote their role and to improve nurse's perception about the APN role in clinical practice. Conclusion: This research provided new evidence to support the need to raise understanding of the role of advanced nurse practitioners among nurse members, advanced nurses and clinical nurse specialists who wish to enhance quality healthcare delivery and job satisfaction in the Kingdom of Saudi Arabia. Recognizing the factors that comprise the function and status of APNs will assist health-care officials to make informed decisions when designing a national policy and a plan for the implementation and the development of the role of APNs.
The organizational and performance effects of nurse practitioner roles
Journal of Advanced Nursing, 2004
The organizational and performance effects of nurse practitioner roles Background. Most studies evaluating the roles of Nurse Practitioners have compared the care delivered by individual Nurse Practitioners with that provided by other professionals. These studies should be complemented by research focusing on a higher unit of analysis, namely the organization of the care process for a specific patient group. The most important reason is that Nurse Practitioners are increasingly involved in direct, multiprofessional care in complex health care organizations and networks. In these work settings, their roles may, in both positive and negative ways, lead to changes in the organization of the entire care delivery system. Aim. The aim of this paper is to stimulate awareness and evaluation of these organizational changes and their potential impact on the effectiveness of the care process. Approach. A conceptual model based on patterned systems contingency theory is proposed. With the help of this model, attention is drawn to issues at the level of the organization and the effectiveness of the care processes that merit attention when Nurse Practitioner positions are being introduced. These issues are derived from case studies in Dutch hospitals. Results. According to the model, a Nurse Practitioner position will change the work structure of the care process involved. Therefore, the effectiveness of a Nurse Practitioner position will be dependent on the changes realized in the work structure. The resulting structure should fit the task characteristics of the care services demanded by the specific patient group. On the basis of this model and the examples presented, questions for further study are formulated. Conclusions. Nurse Practitioner roles can only enhance the effectiveness of care processes when embedded in a work structure that is internally consistent and adjusted to the task environment and available skill-mix. A structural contingency framework may be helpful in identifying relevant organizational issues. To determine the effects of Nurse Practitioner roles, cross-sectional as well as longitudinal studies are needed.
Journal of Clinical Nursing, 2005
The aims of this project were to investigate awareness and foster understanding of the concept of the nurse practitioner and to facilitate and support the development of nurse practitioner roles within an acute hospital trust. A limited understanding of and minimal support for the development of the nurse practitioner (NP) role were identified within an acute hospital trust in the south of England. This was the impetus for pursuing the project outlined in this paper. THEORETICAL PERSPECTIVE: The project used practice development theory synonymously with action research methodology comprising of four action research cycles. Data were collected in a variety of ways within the four overlapping cycles using formal and informal methods, which were analysed concurrently during the project. Techniques included questionnaires, semi-structured interviews, meetings, discussions and the project leader's field notes' diary. A better understanding of the concept and support for NP posts were enhanced across the trust. A Nurse Practitioner Development Group (NPDG) was established, which helped to facilitate the development of NP posts. An example of such a post was established within a NP-led gynaecology pre-operative assessment clinic, which was a pilot project and constituted Action Research cycle 3. It is concluded that the development of NP roles, with the support of a NPDG, within an agreed strategy offers a robust process for NP development within an acute hospital setting. This project demonstrated how practice development and action research might be used together as a systematic process for developing and supporting professional roles that aim to improve the quality of patient care and the effectiveness of health care services.