Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands

The psychiatric-mental health nurse practitioner as coordinating practitioner in the Netherlands: A multiple case study

BACKGROUND

Psychiatric-mental health nurse practitioners (PMHNPs) in the Netherlands have been allowed to perform the role of coordinating practitioner (CP) since 2018. This role is reserved for mental health care specialists who are trained and qualified at the master's degree level. Earlier studies have not addressed how PMHNPs perform that role and what mechanisms and contextual factors determine their performance. This understanding could help optimize their performance in this role and promote effective deployment of PMHNPs in mental health care.

PURPOSE

To understand how PMHNPs perform this role and what mechanisms and contextual factors underlie that performance.

METHODOLOGY

A multiple case study involving PMHNPs who work in various settings as CPs. Data were collected and analyzed using the realistic evaluation approach.

RESULTS

We identified four mechanisms related to the performance of PMHNPs in the role of CP: (1) autonomous performance; (2) unique expertise; (3) accessibility, availability, and professional involvement; and (4) additional roles. The extent to which these mechanisms are present is largely determined by organizational factors, team factors, and individual factors.

CONCLUSIONS

Psychiatric-mental health nurse practitioners are seeking to identify and interpret the role of CP. This study helps to elucidate the mechanism of role performance by PMHNPs and what they should focus on to deliver effective and patient-centered mental health care.

IMPLICATIONS

Policymakers, health care professionals, and educators should consider the mechanisms and contextual factors to facilitate and support PMHNPs' employment and training in the role of CP.

The added value of the nurse practitioner: An evolutionary concept analysis

AIM

Nurse practitioners' added value is often mentioned in publications, but there is no consensus on what value is being added, what value is being added to, and in comparison with what can be considered to be an added value. A concept analysis was conducted to clarify the attributes, antecedents and meaning and better understand the Nurse practitioners' added value.

DESIGN

Rodgers' evolutionary concept analysis.

METHODS

We selected 16 studies from CINAHL, PubMed, Embase and Medline to conduct a thematic analysis, considering the date, location and discipline of publications.

RESULTS

Nurse practitioners' added value include: skills and competencies, activities performed, positive outcomes, and positive role perceptions, and antecedents and consequences were also identified. Nurse practitioners' added value is context-dependent and is often understood by comparing it to a context prior to implementation or other professional roles.

The advanced nurse practitioner in context: Systemic processes

BACKGROUND

Healthcare systems are becoming increasingly complex. Systems thinking can help us to understand this complexity and how to apply that understanding to design and evaluate interventions that improve health outcomes. With the current emphasis on developing advanced nursing practice, it is timely to examine systemic processes that characterize ANP systems and their interactions with wider healthcare systems, and how these processes enable and constrain the role.

OBJECTIVE

To make explicit the systemic processes that characterize the Advanced Nurse Practitioner (ANP) system and how they enable and constrain the role.

DESIGN

An interpretive descriptive study.

SETTING

The study was conducted in a large Hospital Group, consisting of eleven acute hospitals, within the Irish Healthcare System.

PARTICIPANTS

Twenty nine participants, including ANPs, nurses, nurse managers, medics and allied health professionals, participated in the study.

METHODS

Data were collected through seven in-depth interviews and four focus groups. Data were analyzed using the Organic Systems Framework (OSF), where attention was on language indicative of the processes of individuation, integration, differentiation and homogenization.

RESULTS

Participants emphasize how ANP systems exert power by individuating and differentiating; however, restrictive regulations and medical control constrain this power. Integration and homogenization are expressed as ANPs encourage and engage in collaborative practice towards common purposes. When hierarchical structures and professional self-interest dominate, however, these processes are submerged, resulting in unbalanced systems.

CONCLUSION

ANP systems realize their power through increased autonomy by individuating and differentiating. Hierarchical structures positioning ANPs in subservient roles should be challenged. Processes of integration and homogenization are expressed in collaborative practices. We recommend that ANPs realize and articulate the value and diversity that they bring to health systems to strengthen their contribution to them.

CLINICAL RELEVANCE

Lack of awareness of the systemic processes that enable and constrain the ANP role affects the role's potential contribution to the healthcare system. Systems thinking and employing the OSF as an analysis framework can help us to understand these processes and their implications, and how to apply that understanding to design and evaluate interventions that improve health outcomes.