The nurse practitioner role: Solution or servant in improving primary health care service delivery

Implementing Full Practice Authority for Advanced Practice Registered Nurses: A Case for Mitigating Critical Mental Health Services

The COVID-19 pandemic has highlighted some perverse health disparities that we know have long existed in the United States. Disparities related to access, affordability, and cultural appropriateness of care cannot be overemphasized. More importantly, disparities related to provider shortages continue to contribute to adverse patient outcomes, particularly in rural areas and other socioeconomically deprived communities. Despite the push from the National Council of State Boards of Nursing (NCSBN) to ensure adoption and implementation of full practice authority (FPA) of advanced practice registered nurses (APRNs), currently only 28 states in the United States have achieved this goal. In addition, there are some states such as Florida that recently passed legislation supporting FPA for primary care APRNs, yet still have practice restrictions for specialty APRNs, such as mental health. The evidence is clear that patients managed by APRNs have better or comparable outcomes to those managed by physicians; thus, more advocacy is needed to ensure that all states and territories achieve this very important milestone for the profession as it has the potential to foster a collaborative interdisciplinary approach to patient care, which at the same time produces positive patient outcomes, employee satisfaction, and a work environment in which all members of the care team feel valued and autonomous.

Nurse visit utilization and blood pressure control: A multi-cohort study in New Zealand

OBJECTIVE

This study aimed to retrospectively examine the contribution of nurses to population health outcomes with reference to nurse visits and blood pressure measurement in primary health settings.

DESIGN

A retrospective study was conducted using New Zealand Health Survey (NZHS) from 2012 to 2017.

SAMPLE

Adult population who are 18 years old and over living in New Zealand.

MEASUREMENTS

Age, gender, and ethnicity, the service utilization of primary health care nurse visit and blood pressure measurement were extracted from the NZHS (2012-2017) to compare with the service utilization of primary health care nurses by different demographic groups.

RESULTS

Females who have treated hypertension shows higher utilization of nurse visit than males. From 2015 to 2017, the participants in this cohort have visited a primary health care nurse at least more than once within a year. With blood pressure control, the overall pooled results show the impact of visiting primary health nurses on systolic and diastolic blood pressure control.

CONCLUSION

Our study at a national scale, demonstrated the impact of nurse's contribution to population health outcomes among people living with hypertension in New Zealand. Nurses are key to improving population health outcomes and to achieve universal health coverage.

Nursing in a different world: Remote area nursing as a specialist-generalist practice area

OBJECTIVE

Remote area nurses provide primary health care services to isolated communities across Australia. They manage acute health issues, chronic illness, health promotion and emergency responses. This article discusses why their generalist scope of practice should be formally recognised as a specialist nursing practice area.

DESIGN

Constructivist grounded theory, using telephone interviews (n = 24) with registered nurses and nurse practitioners.

SETTING

Primary health care clinics, in communities of 150-1500 residents across Australia.

PARTICIPANTS

A total of 24 nurses participated in this study.

RESULTS

Nurses' perceived their clinical knowledge and skill as insufficient for the advanced, generalist, scope of practice in the remote context, especially when working alone. Experience in other settings was inadequate preparation for working in remote areas. Knowledge and skill developed on the job, with formal learning, such as nurse practitioner studies, extending the individual nurse's scope of practice to meet the expectations of the role, including health promotion.

CONCLUSION

Remote area nursing requires different knowledge and skills from those found in any other nursing practice setting. This study supports the claim that remote area nursing is a specialist-generalist role and presents a compelling case for further examination of the generalist education and support needs of these nurses. Combined with multidisciplinary collaboration, developing clinical knowledge and skill across the primary health care spectrum increased the availability of health resources and subsequently improved access to care for remote communities. Further research is required to articulate the contemporary scope of practice of remote area nurses to differentiate their role from that of nurse practitioners.

Nurse practitioner locums: a plausible solution for augmenting health care access for rural communities

With 2020 being designated the Year of the Nurse and Midwife, it is opportune to acknowledge and recognise the role that nurses undertake in primary care environments. Nurses and midwives play a pivotal role in the delivery of high-quality health care, particularly in geographically challenged areas of Australia, where they may be the only provider of care within their communities. Rural and remote health services require strategic planning to develop and implement solutions responsive to the challenges of rural and remote communities. Maintenance of health services in rural and remote areas is a challenge, crucial to the equity of health outcomes for these communities. Many small communities rely on visiting medical officers to provide the on-call care to facility services, including emergency departments, urgent care centres, acute wards and aged care facilities. It is increasingly difficult to maintain the current rural workforce models, particularly the provision of after-hours 'on-call' care necessary in these communities. An alternative model of health care service delivery staffed by nurse practitioners (NP) is one proposed solution. NPs are educated, skilled and proven in their ability to provide an after-hours or on-call service to meet the expectations of rural and remote communities. Achievement of high-quality health care that is cost-efficient, safe and demonstrates improved patient outcomes has been reported in NP-led health care delivery impact evaluations. The value of an NP locum service model is the provision of a transparent, reliable service delivering consistent, equitable and efficient health care to rural and remote communities.

Perspectives of Quebec Primary Health Care Nurse Practitioners on Their Role and Challenges in Chronic Disease Management: A Qualitative Study

BACKGROUND

Primary health care nurse practitioners (PHCNPs) can play a key role in chronic disease management. However, little is known about the challenges they face.

PURPOSE

The study aimed to describe PHCNPs' perspectives on their role for patients with chronic health conditions, the barriers they face, and facilitating factors.

METHODS

A qualitative descriptive exploratory study was conducted with 24 PHCNPs in the Canadian province of Quebec.

RESULTS

PHCNPs believe that they are in an optimal position to address the needs of patients with chronic health conditions, especially in providing self-management support. However, PHCNPs reported feeling pressured to practice according to a biomedical model and to constantly defend their role in chronic disease management. They feel that they are frequently being diverted from their role to compensate for the lack of family doctors. PHCNPs made concrete recommendations to optimize their autonomous practice and quality of care: promoting strong interprofessional communication skills, genuine mentoring relationships between PHCNPs and partner physicians, managers upholding the full scope of PHCNPs' practice, and a more flexible legislative framework.

CONCLUSIONS

The original conception of PHCNPs as health professionals with unique characteristics is at stake. The factors that should be targeted to support the autonomy of PHCNPs were identified.

Understanding the Roles, Responsibilities, and Competencies of Advanced Practice Registered Nurses: Instrument Development and Psychometric Testing

BACKGROUND AND PURPOSE

Demand for primary care providers increases value for advanced practice registered nurses (APRNs) to assume more independent roles. The purpose was to develop a reliable, valid instrument to measure roles, responsibilities, and competencies reflective of autonomous practice for APRNs.

METHODS

Conceptual literature motivated development of a new instrument. Validity was initially evaluated through expert content review. Reliability of proposed scales was evaluated and possible underlying constructs were identified through factor analysis using data from a pilot study.

RESULTS

Content validity for the instrument was high (content validity index [CVI] 88). The 16-item instrument is highly reliable (Cronbach's alpha of 0.81). Cronbach's alphas for subscales ranged from 0.60 to 0.75. Factor analysis identified four components.

CONCLUSIONS

The Petersen Sieloff Assessment of Advanced Practice (PSAAP) demonstrated initial reliability. Additional examination is warranted to further improve the factor structure.

The care of nurses in the Family Health Strategy: practices and theoretical foundation

OBJECTIVE

To analyze the practices of nurses working in the Family Health Strategy (FHS) in a city of Rio de Janeiro (RJ) and the theoretical foundations that guide them.

METHOD

Qualitative research through semi-structured interviews with twelve nurses working in eleven FHS units between August and December 2014. Data were organized by hermeneutic-dialectical analysis.

RESULTS

The nurse is inserted in the municipal FHS as care coordinator and political agent; has practices aimed at welcoming, mobilizing social groups, making technical and monitoring of users through health programs. The practices remain in the confrontation of problems and are guided by technical manuals and coordination of health programs.

FINAL CONSIDERATIONS

Studies are needed to recognize the nurse's therapeutic objective at the FHS and to propose theoretical foundations, specific to Nursing or Collective Health that will instrumentalize their daily practice.

Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study

AIM

To provide insight into the impact of substituting general practitioners with nurse practitioners in out-of-hours services on: (1) the number of patients; and (2) general practitioners' caseload (patient characteristics, urgency levels, types of complaints).

BACKGROUND

General practitioners' workload during out-of-hours care is high, and the number of hours they work out-of-hours has increased, which raises concerns about maintaining quality of care. One response to these challenges is shifting care to nurse practitioners.

DESIGN

Quasi-experimental study comparing differences between and within out-of-hours teams: experimental, one nurse practitioner and four general practitioners; control, five general practitioners.

METHODS

Data of 12,092 patients from one general practitioners cooperative were extracted from medical records between April 2011 and July 2012.

RESULTS

The number of patients was similar in the two study arms. In the experimental arm, the nurse practitioner saw on average 16·3% of the patients and each general practitioner on average 20·9% of the patients. General practitioners treated more older patients; higher urgency levels; and digestive, cardiovascular and neurological complaints. Nurse practitioners treated more patients with skin and respiratory complaints. Substitution did not lead to a meaningful increase of general practitioners' caseload.

CONCLUSION

The results show that nurse practitioners can make a valuable contribution to patient care during out-of-hours. The patients managed and care provided by them is roughly the same as general practitioners. In areas with a shortage of general practitioners, administrators could consider employing nurses who are competent to independently treat patients with a broad range of complaints to offer timely care to patients with acute problems.