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Kempen TGH, Benaissa Y, Molema H, Valk LE, Hazen ACM, Heringa M, Kwint HF, Zwart DLM, Kälvemark Sporrong S, Stewart D, van Dijk L. Pharmacists' current and potential prescribing roles in primary care in the Netherlands: a case study. J Interprof Care 2024; 38:787-798. [PMID: 38985094 DOI: 10.1080/13561820.2024.2374017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/11/2024]
Abstract
In some countries, pharmacists have obtained prescribing rights to improve quality and accessibility of care and reduce physician workload. This case study explored pharmacists' current roles in and potential for prescribing in primary care in the Netherlands, where prescribing rights for pharmacists do not exist. Participatory observations of pharmacists working in either general practice or community pharmacy were conducted, as were semi-structured interviews about current and potential practice. The latter were extended to patients and other healthcare professionals, mainly general practitioners, resulting in 34 interviews in total. Thematic analyses revealed that pharmacists, in all cases, wrote prescriptions that were then authorized by a physician before dispensing. General practice-based pharmacists often prescribed medications during patient consultations. Community pharmacists mainly influenced prescribing through (a) medication reviews where the physician and/or practice nurse often were consulted to make treatment decisions, and (b) collaborative agreements with physicians to start or substitute medications in specific situations. These findings imply that the pharmacists' current roles in prescribing in the Netherlands resemble collaborative prescribing practices in other countries. We also identified several issues that should be addressed before formally introducing pharmacist prescribing, such as definitions of tasks and responsibilities and prescribing-specific training for pharmacists.
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Affiliation(s)
- Thomas G H Kempen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Yosra Benaissa
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Haijo Molema
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | - Lea E Valk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ankie C M Hazen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Henk-Frans Kwint
- SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands
| | - Dorien L M Zwart
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands
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Kempen TG, van Dijk L, Floor-Schreudering A, Kohli A, Kwint HF, Schackmann L, van Tuyl LH, Heringa M. Potential for pharmacist prescribing in primary care: A Dutch citizen perspective. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 14:100453. [PMID: 38873026 PMCID: PMC11170179 DOI: 10.1016/j.rcsop.2024.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/13/2024] [Accepted: 05/21/2024] [Indexed: 06/15/2024] Open
Abstract
Background Medication prescribing by pharmacists is a task shifting approach to help ensure quality and accessibility of healthcare. In many countries, like the Netherlands, pharmacist prescribing is not legally ensured, and it is unknown what citizens think of its potential introduction. Objective To investigate citizen perspectives on the potential role of pharmacists in prescribing in primary care. Methods A Citizen Platform with citizens (>18 years) from the Netherlands was conducted in October 2022. This consisted of a one-day program in which the participants were engaged in interactive assignments and received expert presentations to foster the development of informed opinions. In the final assignment, 3 participant groups designed their ideal future scenario including preconditions regarding the role of the pharmacist in prescribing in primary care. All assignments were recorded, and notes were taken. The researchers then consolidated the 3 scenarios into one version and categorized the preconditions. The Citizen Platform results were summarized and subsequently discussed in 2 online focus groups with other citizens in February 2023 to investigate the perspectives of less informed citizens. Focus group discussions were audio-recorded, transcribed, and thematically analyzed. Results The Citizen Platform (n = 10) resulted in a shared scenario involving a primary care center where general practitioners (GPs) pharmacists and other healthcare professionals collaborate as a team. In this scenario, pharmacists can modify treatment in certain chronic diseases, manage minor ailments and support GPs with the care for patients with complex needs. Preconditions needed to realize this scenario include having shared medical records, the GP retaining the overview of the care for the patient and additional training for pharmacists. The focus groups (n = 6, in total) yielded 5 themes which acknowledge potential pharmacist prescribing but depict a more skeptical view towards pharmacist prescribing and include several concerns, for example pharmacists' potential conflict of interest. Conclusions Citizens that are informed about opportunities for pharmacy prescribing are capable of sketching potential scenarios for pharmacist prescribing in a collaborative primary care context. Less informed citizens seem more skeptical towards pharmacist prescribing.
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Affiliation(s)
- Thomas G.H. Kempen
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | - Liset van Dijk
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, University of Groningen, the Netherlands
| | | | - Aradhana Kohli
- Ministry of Health, Welfare and Sport, the Hague, the Netherlands
- FLeiR Apotheek Parkwijk, Utrecht, the Netherlands
| | - Henk-Frans Kwint
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands
| | - Laura Schackmann
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Lilian H.D. van Tuyl
- Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Mette Heringa
- SIR Institute for Pharmacy Practice and Policy, Leiden, the Netherlands
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Joyce P, Alexander L. A survey exploring factors affecting employment of physician associates in Ireland. Ir J Med Sci 2023; 192:2041-2046. [PMID: 36600116 PMCID: PMC10522502 DOI: 10.1007/s11845-022-03255-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In the Republic of Ireland, the employment of physician associates (PAs) is growing. Following a pilot project in a hospital setting, PAs are now employed across primary and secondary care in public and private sectors. Most of the Irish PA graduates are working in hospital settings. AIMS The aim of the study was to explore factors which supported or inhibited the employment of PAs in Irish hospital settings and the perceived supports or challenges for potential employers in recruiting PAs. METHODS An online survey gathered data via human resources departments of public and private hospitals, with a 25% response rate. RESULTS Similar to previous studies, the barriers included the lack of recognition and regulation of the role and the small number of PAs to fill available posts. Enablers, which influenced the employment of PAs, included improving workflow, continuity of care and helping to address junior doctors' working hours. CONCLUSIONS Our data suggests that there is a keen interest and willingness to employ PAs and there is great potential to expand the role in Irish healthcare. However, there are some key issues around funding and recognition to be addressed at government level for this profession to highlight its worth.
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Affiliation(s)
- Pauline Joyce
- RCSI: Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Lisa Alexander
- RCSI: Royal College of Surgeons in Ireland, Dublin, Ireland
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Dankers-de Mari EJCM, van Vught AJAH, Visee HC, Laurant MGH, Batenburg R, Jeurissen PPT. The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000-2022: a multimethod approach study. BMC Health Serv Res 2023; 23:580. [PMID: 37280653 DOI: 10.1186/s12913-023-09568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/17/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Many countries are looking for ways to increase nurse practitioner (NP) and physician assistant/associate (PA) deployment. Countries are seeking to tackle the pressing issues of increasing healthcare demand, healthcare costs, and medical doctor shortages. This article provides insights into the potential impact of various policy measures on NP/PA workforce development in the Netherlands. METHODS We applied a multimethod approach study using three methods: 1) a review of government policies, 2) surveys on NP/PA workforce characteristics, and 3) surveys on intake in NP/PA training programs. RESULTS Until 2012, the annual intake into NP and PA training programs was comparable to the number of subsidized training places. In 2012, a 131% increase in intake coincided with extending the legal scope of practice of NPs and PAs and substantially increasing subsidized NP/PA training places. However, in 2013, the intake of NP and PA trainees decreased by 23% and 24%, respectively. The intake decreased in hospitals, (nursing) home care, and mental healthcare, coinciding with fiscal austerity in these sectors. We found that other policies, such as legal acknowledgment, reimbursement, and funding platforms and research, do not consistently coincide with NP/PA training and employment trends. The ratios of NPs and PAs to medical doctors increased substantially in all healthcare sectors from 3.5 and 1.0 per 100 full-time equivalents in medical doctors in 2012 to 11.0 and 3.9 in 2022, respectively. For NPs, the ratios vary between 2.5 per 100 full-time equivalents in medical doctors in primary care and 41.9 in mental healthcare. PA-medical doctor ratios range from 1.6 per 100 full-time equivalents in medical doctors in primary care to 5.8 in hospital care. CONCLUSIONS This study reveals that specific policies coincided with NP and PA workforce growth. Sudden and severe fiscal austerity coincided with declining NP/PA training intake. Furthermore, governmental training subsidies coincided and were likely associated with NP/PA workforce growth. Other policy measures did not consistently coincide with trends in intake in NP/PA training or employment. The role of extending the scope of practice remains to be determined. The skill mix is shifting toward an increasing share of medical care provided by NPs and PAs in all healthcare sectors.
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Affiliation(s)
- Ellen J C M Dankers-de Mari
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Anneke J A H van Vught
- School of Health Studies, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Hetty C Visee
- Regioplan, Jollemanhof 18, Amsterdam, 1019 GW, The Netherlands
| | - Miranda G H Laurant
- School of Health Studies, HAN University of Applied Sciences, P.O. Box 6960, 6503 GL, Nijmegen, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research, NIVEL, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Patrick P T Jeurissen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Small Fiber Neuropathy: A Clinical and Practical Approach. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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de Haan M, van Eijk-Hustings Y, Bessems-Beks M, De Bruijn-Geraets D, Dirksen C, Vrijhoef H. Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study. PLoS One 2023; 18:e0281053. [PMID: 36857391 PMCID: PMC9976997 DOI: 10.1371/journal.pone.0281053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 01/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Expected rise in the demand for healthcare and a dropping supply of healthcare professionals, has generated an increased interest in the most effective deployment of healthcare professionals. Consequently, task shifting has become a common strategy to redistribute tasks between established professional groups, however, little is known about the effects of shifting tasks to emerging professional groups. The aim of this study was to evaluate a legal amendment to facilitate task shifting to an emerging profession in Dutch healthcare: Clinical Technologists (CTs). CTs were introduced and provided an Extended Scope of Practice (ESP) to perform nine 'reserved procedures' independently. METHODS A concurrent multi-phase mixed methods study was used to evaluate whether a legal amendment to facilitate task shifting to CTs was effective and efficient. RESULTS The results show that CTs use their ESP frequently to perform five categories of reserved procedures independently and suggest that the ESP increased the efficiency of care delivery for those procedures. Additionally, the findings highlight that task shifting was influenced by the setting in which CTs worked, time allotted to patient-contact as well as external factors (e.g., financing). CONCLUSIONS This study provides tentative lessons for policymakers on how task shifting to emerging professional groups can be improved. Providing a legal amendment to facilitate task shifting to CTs seems to be effective and efficient. However, it also poses multiple challenges. While established professional groups can face similar challenges, it is likely that these are exacerbated for emerging professional groups, particularly when shifting tasks occurs horizontally.
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Affiliation(s)
- Maarten de Haan
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- National Healthcare Institute (Zorginstituut Nederland), Diemen, The Netherlands
- * E-mail:
| | - Yvonne van Eijk-Hustings
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Monique Bessems-Beks
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Daisy De Bruijn-Geraets
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Carmen Dirksen
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Clinical Trial Center Maastricht (CTCM), Maastricht, The Netherlands
| | - Hubertus Vrijhoef
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, The Netherlands
- Panaxea b.v., Amsterdam, The Netherlands
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Grota T, Betihavas V, Burston A, Jacob E. Impact of nurse-surgeons on patient-centred outcomes: A systematic review. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100086. [PMID: 38745634 PMCID: PMC11080547 DOI: 10.1016/j.ijnsa.2022.100086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Nurse-surgeons have been performing surgeries for decades. Yet, their impact on perioperative clinical outcomes has not been explored in detail. Objective To investigate the impact of nurse-surgeons on patient-centred outcomes. Design Systematic review. Method The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram and checklist for systematic reviews were used as the screening and reporting guideline. CINAHL, Cochrane Library, MEDLINE, and PubMed databases were searched for articles that fit the review's eligibility criteria. A combination of Medical Subject Headings, keywords and filters for each database were used. Following screening and full text review, the Mixed Methods Appraisal Tool was used for quality assessment and the Grading of Recommendations, Assessment, Development and Evaluations framework for certainty and confidence assessment. Narrative synthesis was used to report the findings due to the design heterogeneity of the included studies. Results Forty-eight (n = 48) patient-centred outcomes were identified from 25 included studies. These outcomes were grouped into four categories: patient satisfaction and experience; waiting list; perioperative complications; and quality of surgical care. Patient satisfaction and experience was rated high to very high in 16 studies; none reported patient dissatisfaction. Waiting lists improved in eight studies. Perioperative complications were none to very low in nine studies. Mortality rates in the nurse-surgeon group were better than the physician group in three studies. The quality of care in the performance of surgeries by nurse-surgeons was either similar or better than physicians in ten studies. Conclusions Nurse-surgeons performed safe, satisfactory, and high-quality surgeries with minimal perioperative complications similar to physicians. The use of nurse-surgeons has significantly reduced waiting lists regardless of surgical speciality. Policies around nurse-surgeon practice needs to be developed at national and international levels to streamline the delivery of much needed surgical services amidst the coronavirus pandemic in the areas of cancer diagnostic surgeries, emergency surgeries, minor surgeries, and remote and rural health.
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Affiliation(s)
- Tenber Grota
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
| | - Vasiliki Betihavas
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
| | - Adam Burston
- Nursing Research and Practice Development Centre, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Elisabeth Jacob
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, NSW 2060, Australia
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Vara-Ortiz MÁ, Fabrellas Padrés N. [Impact of training and legal aspects on the application of nurse demand management by primary care nurses in Catalonia]. Aten Primaria 2022; 54:102491. [PMID: 36272398 PMCID: PMC9586855 DOI: 10.1016/j.aprim.2022.102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/28/2022] [Indexed: 12/02/2022] Open
Abstract
Objetivo Conocer la experiencia de las enfermeras de atención primaria en la aplicación de la gestión enfermera de la demanda (GED). Diseño Estudio observacional, descriptivo y transversal. Emplazamiento Atención primaria de Cataluña. Participantes Enfermeras de atención primaria de Cataluña. Se estimó una muestra de 394 participantes alcanzando 405. La obtención de datos fue desde octubre de 2021 hasta enero de 2022. Mediciones principales Se realizó un cuestionario ad hoc, el cual exploraba aspectos referentes a la experiencia de aplicación de la GED: definición y manejo del programa, formación y aspectos legales del programa. Resultados Las enfermeras entienden la GED como un triaje. Además, consideran que la implantación de la prescripción enfermera no mejora la aplicación de la GED. Manifiestan una falta de formación especialmente las enfermeras más noveles. La formación ideal en GED, consideran, debería incluir fisiopatología y supuestos prácticos. Siete de cada 10 enfermeras desconocen el marco legal que ampara la GED y les provoca inseguridad no conocerlo. Seis de cada 10 han dejado de ser resolutivas por miedo a las repercusiones legales. Las enfermeras que sí conocen el marco legal son las que han dejado de resolver en menor proporción. Conclusiones Se constata la necesidad de formación general en la GED y en los aspectos legales que dan cobertura al programa especialmente en las enfermeras más jóvenes y con menos experiencia en atención primaria. De esta manera se mejorará la aplicación y aceptación del rol autónomo enfermero en la gestión de enfermedades agudas leves.
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Affiliation(s)
- María Ángeles Vara-Ortiz
- Escola d'Infermeria, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, España; Centro de Atención Primaria Barri Llatí, Santa Coloma de Gramenet, Barcelona, España.
| | - Núria Fabrellas Padrés
- Escola d'Infermeria, Universitat de Barcelona, Hospitalet de Llobregat, Barcelona, España
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Doumen M, Westhovens R, Vandeputte M, Van Melder R, Van der Elst K, Pazmino S, Bertrand D, Stouten V, Van Laeken E, Creten N, Neys C, Verschueren P, De Cock D. The perception of stakeholders on the applicability of nurse-led clinics in the management of rheumatoid arthritis. Rheumatol Adv Pract 2021; 5:ii45-ii52. [PMID: 34755028 PMCID: PMC8570152 DOI: 10.1093/rap/rkab052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/06/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives RA should be treated to target in a process of shared decision-making with patients. Person-centred care is essential to meeting specific patient needs. Nurse-led clinics, where a nurse is responsible for care, have demonstrated added value in some countries but are still not implemented widely. This study aimed to explore stakeholders’ perceptions of advantages, disadvantages and conditions for the implementation of nurse-led clinics for RA in Belgium. Methods We performed a cross-sectional qualitative study consisting of five semi-structured focus group interviews. Rheumatology nurses, patients with RA and rheumatologists were interviewed as stakeholders. The analysis was carried out by three researchers according to the Qualitative Analysis Guide of Leuven (QUAGOL), formulating a conceptual framework of overarching themes and deconstructing this into perceived advantages, disadvantages and conditions. Results Two focus groups with nurses (total n = 16), two with patients (n = 17) and one with rheumatologists (n = 9) were conducted. The interview synthesis resulted in five overarching themes across stakeholders: efficiency of care, disease management, legal and organizational requirements, the conventional role of the nurse and the extended role of the nurse. All stakeholders perceived additional education for nurses as essential, but rheumatologists debated nurses’ abilities to lead a rheumatology clinic. Furthermore, patients preferred care protocols to guide nurses, and care providers approached this reluctantly. Generally, patients with a well-controlled disease were perceived as the ideal candidates for nurse-led care. Conclusion Nurse-led clinics could provide many benefits but require additional nurse education and a legal and organizational framework before being implemented widely and successfully.
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Affiliation(s)
- Michaël Doumen
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven.,Rheumatology, University Hospitals Leuven
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven.,Rheumatology, University Hospitals Leuven
| | | | - Rani Van Melder
- Academic Centre for Nursing and Midwifery, KU Leuven, Leuven
| | | | - Sofia Pazmino
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
| | - Delphine Bertrand
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
| | - Veerle Stouten
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
| | | | | | | | - Patrick Verschueren
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven.,Rheumatology, University Hospitals Leuven
| | - Diederik De Cock
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Centre, KU Leuven
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10
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Kuilman L, Jansen G, Mulder LB, Roodbol P. Facilitating and motivating factors for reporting reprehensible conduct in care: A study among nurse practitioners and physician assistants in the Netherlands. J Eval Clin Pract 2021; 27:776-784. [PMID: 32816369 PMCID: PMC8359255 DOI: 10.1111/jep.13462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/24/2020] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The aims of this study are as follows: (a) to establish whether a relationship exists between the importance that healthcare professionals attach to ethics in care and their likelihood to report reprehensible conduct committed by colleagues, and (b) to assess whether this relationship is moderated by behavioural control targeted at preventing harm. METHOD In this cross-sectional study, which was based on a convenience sample (n = 155) of nurse practitioners (NPs) and physician assistants (PAs) in the Netherlands, we measured ethics advocacy (EA) as a motivating factor (reflecting the importance that healthcare professionals attach to ethics and care) and "behavioral control targeted at preventing harm" (BCPH) as a facilitating factor. "Reporting reprehensible conduct" (RRC) was measured as a context-specific indicator of whistleblowing intentions, consisting of two vignettes describing morally questionable behaviour committed by colleagues. RESULTS The propensity to report reprehensible conduct was a function of the interaction between EA and BCPH. The only group for which EA predicted RRC consisted of individuals with above-average levels of perceived BCPH. CONCLUSION The results suggest that the importance that healthcare professionals attach to ethical aspects in care is not sufficient to ensure that they will report reprehensible conduct. Such importance does not induce reporting behaviour unless the professionals also perceive themselves as having a high level of BCPH. We suggest that these insights could be helpful in training healthcare providers to cope with ethical dilemmas that they are likely to encounter in their work.
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Affiliation(s)
- Luppo Kuilman
- Nursing Research Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Physician Assistant Studies, Northern Arizona University, College of Health and Human Services, Phoenix BMC, Arizona, USA
| | - Gerard Jansen
- Nursing Research Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Laetitia B Mulder
- Department of Human Resource Management & Organizational Behaviour, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Petrie Roodbol
- Nursing Research Section, Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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11
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de Vries F, Welbie M, Tjin E, Driessen R, van de Kerkhof P. Reallocations in acne healthcare: exploring the possible roles and added value of non-physicians by a mixed-methods study design. BMC Health Serv Res 2021; 21:746. [PMID: 34315450 PMCID: PMC8317412 DOI: 10.1186/s12913-021-06744-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background A highly promoted opportunity for optimizing healthcare services is to expand the role of non-physician care providers by care reallocation. Reallocating care from physicians to non-physicians can play an important role in solving systemic healthcare problems such as care delays, hospital overcrowding, long waiting lists, high work pressure and expanding healthcare costs. Dermatological healthcare services, such as the acne care provision, are well suited for exploring the opportunities for care reallocation as many different types of care professionals are involved in the care process. In the Netherlands, acne care is mainly delivered by general practitioners and dermatologists. The Dutch healthcare system also recognizes non-physician care providers, among which dermal therapists and beauticians are the most common professions. However, the role and added value of non-physicians is still unclear. The present study aimed to explore the possibilities for reallocating care to non-physicians and identify drivers for and barriers to reallocation. Methods A mixed-method design was used collecting quantitative and qualitative data from representatives of the main 4 Dutch professions providing acne care: dermatologists, GP’s, Dermal therapists and beauticians. Results A total of 560 questionnaires were completed and 24 semi-structured interviews were conducted. A broad spectrum of non-physician tasks and responsibilities were delineated. Interviewed physicians considered acne as a low-complexity skin condition which made them willing to explore the possibilities for reallocating. A majority of all interviewees saw a key role for non-physicians in counselling and supporting patients during treatment, which they considered an important role for increasing patients’ adherence to proposed treatment regimes, contributing to successful clinical outcome. Also, the amount of time non-physicians spend on patients was experienced as driver for reallocation. Legislation and regulations, uncertainties about the extent of scientific evidence and proper protocols use within the non-physician clinical practice were experienced as barriers influencing the possibilities for reallocation. Conclusions Delineated roles and drivers demonstrate there is room and potential for reallocation between physicians and non-physicians within acne healthcare, when barriers are adequately addressed. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06744-2.
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Affiliation(s)
- Femke de Vries
- Research group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands. .,Department of Dermatology, Radboud university medical centre, Nijmegen, The Netherlands.
| | - Marlies Welbie
- Research Group Methodology of Practice-Based Research, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Esther Tjin
- Research group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences, Heidelberglaan 7, 3584 CS, Utrecht, The Netherlands
| | - Rieke Driessen
- Department of Dermatology, Radboud university medical centre, Nijmegen, The Netherlands
| | - Peter van de Kerkhof
- Department of Dermatology, Radboud university medical centre, Nijmegen, The Netherlands
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Hooker RS. Independence and Human Capital Theory for the American Physician Assistant. J Physician Assist Educ 2021; 32:26-27. [PMID: 33605686 DOI: 10.1097/jpa.0000000000000342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Roderick S Hooker
- Roderick S. Hooker, PhD, MBA, PA, is a retired PA who lives in Ridgefield, Washington
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Abstract
Introduction Shifting specialist care from the hospital to primary care/community care (also called primary care plus) is proposed as one option to reduce the increasing healthcare costs, improve quality of care and accessibility. The aim of this systematic review was to get insight in primary care plus provided by physician assistants or nurse practitioners. Methods Scientific databases and reference list were searched. Hits were screened on title/abstract and full text. Studies published between 1990-2018 with any study design were included. Risk of bias assessment was performed using QualSyst tool. Results Search resulted in 5.848 hits, 15 studies were included. Studies investigated nurse practitioners only. Primary care plus was at least equally effective as hospital care (patient-related outcomes). The number of admission/referral rates was significantly reduced in favor of primary care plus. Barriers to implement primary care plus included obtaining equipment, structural funding, direct access to patient-data. Facilitators included multidisciplinary collaboration, medical specialist support, protocols. Conclusions and Discussion Quality of care within primary care plus delivered by nurse practitioners appears to be guaranteed, at patient-level and professional-level, with better access to healthcare and fewer referrals to hospital. Most studies were of restricted methodological quality. Findings should be interpreted with caution.
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van Vught A, van den Brink G, Laurant M. Physician assistants en verpleegkundig specialisten in de anderhalvelijnszorg. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s12445-020-0976-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gysin S, Meier R, van Vught A, Merlo C, Gemperli A, Essig S. Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study. BMC FAMILY PRACTICE 2020; 21:164. [PMID: 32791993 PMCID: PMC7425147 DOI: 10.1186/s12875-020-01240-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
Background Primary care systems around the world have implemented nurse practitioners (NPs) to ensure access to high quality care in times of general practitioner (GP) shortages and changing health care needs of a multimorbid, ageing population. In Switzerland, NPs are currently being introduced, and their exact role is yet to be determined. The aim of this study was to get insight into patient characteristics and services provided in NP consultations compared to GP consultations in Swiss primary care. Methods This case study used retrospective observational data from electronic medical records of a family practice with one NP and two GPs. Data on patient-provider encounters were collected between August 2017 and December 2018. We used logistic regression to assess associations between the assignment of the patients to the NP or GP and patient characteristics and delivered services respectively. Results Data from 5210 patients participating in 27,811 consultations were analyzed. The average patient age was 44.3 years (SD 22.6), 47.1% of the patients were female and 19.4% multimorbid. 1613 (5.8%) consultations were with the NP, and 26,198 (94.2%) with the two GPs. Patients in NP consultations were more often aged 85+ (OR 3.43; 95%-CI 2.70–4.36), multimorbid (OR 1.37; 95%-CI 1.24–1.51; p < 0.001) and polypharmaceutical (OR 1.28; 95%-CI 1.15–1.42; p < 0.001) in comparison to GP consultations. In NP consultations, vital signs (OR 3.05; 95%-CI 2.72–3.42; p < 0.001) and anthropometric data (OR 1.33; 95%-CI 1.09–1.63; p 0.005) were measured more frequently, and lab tests (OR 1.16; 95%-CI 1.04–1.30; p 0.008) were ordered more often compared to GP consultations, independent of patient characteristics. By contrast, medications (OR 0.35; 95%-CI 0.30–0.41; p < 0.001) were prescribed or changed less frequently in NP consultations. Conclusions Quantitative data from pilot projects provide valuable insights into NP tasks and activities in Swiss primary care. Our results provide first indications that NPs might have a focus on and could offer care to the growing number of multimorbid, polypharmaceutical elderly in Swiss primary care.
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Affiliation(s)
- Stefan Gysin
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.
| | - Rahel Meier
- Institute of Primary Care Zurich, University of Zurich and University Hospital Zurich, Zürich, Switzerland
| | - Anneke van Vught
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, the Netherlands
| | - Christoph Merlo
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Stefan Essig
- Institute of Primary and Community Care, Schwanenplatz 7, 6004, Luzern, Switzerland
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Kersbergen MJ, Creugers NHJ, Hollaar VRY, Laurant MGH. Perceptions of interprofessional collaboration in education of dentists and dental hygienists and the impact on dental practice in the Netherlands: A qualitative study. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2020; 24:145-153. [PMID: 31677206 PMCID: PMC7006819 DOI: 10.1111/eje.12478] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/19/2019] [Accepted: 10/30/2019] [Indexed: 05/06/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the perceptions of dentists and dental hygienists regarding their own and each other's roles in interprofessional collaboration following a clinical interprofessional educational programme (CIEP) as part of their graduate programme at Radboud university medical center (Radboudumc) and HAN University of Applied Sciences (HAN UAS), Nijmegen, the Netherlands, respectively. Perceptions were obtained at the end of their study (2014) and two years after their graduation (2016). METHODS A qualitative study was conducted using a questionnaire with open-ended questions. Sixty-two dentists and thirty-eight dental hygienists were invited. Theory-based analyses were applied in combination with principles of Grounded Theory to analyse and synthesise the collected data from the open-ended questions. RESULTS At baseline, 100% responded. At follow-up, thirty-two dentists (51.6%) and twenty-six dental hygienists (68.4%) responded; twenty-seven dentists (43.5%) and eighteen dental hygienists (47.4%) were included. Many similarities were found between baseline and follow-up regarding perceptions of each other's expertise and responsibility, learning from and with each other, and the behaviour of students and the "novice" professionals in interprofessional collaboration. Both dentists and dental hygienists experienced the CIEP as useful for interprofessional collaboration. The "novice" dentists and dental hygienists indicated that in dental practices interprofessional collaboration was less common. CONCLUSION The CIEP resulted in more understanding amongst dentists and dental hygienists with regard to interprofessional roles, but in practice the "novice" dentists and dental hygienists face difficulties in applying the interprofessional roles.
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Affiliation(s)
- Maria J. Kersbergen
- Dental Hygiene Program, Faculty of Health and Social Studies, HAN University of Applied Sciences and Radboud university medical center, Radboud Institute for Health Sciences, Department of DentistryNijmegenThe Netherlands
| | - Nico H. J. Creugers
- Department of Oral Function and Prosthetic Dentistry at College of Dental ScienceRadboud University Medical CenterNijmegenThe Netherlands
| | - Vanessa R. Y. Hollaar
- Dental Hygiene ProgramFaculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
| | - Miranda G. H. Laurant
- Organization of Healthcare and Services at Faculty of Health and Social StudiesHAN University of Applied SciencesNijmegenThe Netherlands
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Maier CB. Nurse prescribing of medicines in 13 European countries. HUMAN RESOURCES FOR HEALTH 2019; 17:95. [PMID: 31815622 PMCID: PMC6902591 DOI: 10.1186/s12960-019-0429-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/29/2019] [Indexed: 05/18/2023]
Abstract
BACKGROUND Nurse prescribing of medicines is increasing worldwide, but there is limited research in Europe. The objective of this study was to analyse which countries in Europe have adopted laws on nurse prescribing. METHODS Cross-country comparative analysis of reforms on nurse prescribing, based on an expert survey (TaskShift2Nurses Survey) and an OECD study. Country experts provided country-specific information, which was complemented with the peer-reviewed and grey literature. The analysis was based on policy and thematic analyses. RESULTS In Europe, as of 2019, a total of 13 countries have adopted laws on nurse prescribing, of which 12 apply nationwide (Cyprus, Denmark, Estonia, Finland, France, Ireland, Netherlands, Norway, Poland, Spain, Sweden, United Kingdom (UK)) and one regionally, to the Canton Vaud (Switzerland). Eight countries adopted laws since 2010. The extent of prescribing rights ranged from nearly all medicines within nurses' specialisations (Ireland for nurse prescribers, Netherlands for nurse specialists, UK for independent nurse prescribers) to a limited set of medicines (Cyprus, Denmark, Estonia, Finland, France, Norway, Poland, Spain, Sweden). All countries have regulatory and minimum educational requirements in place to ensure patient safety; the majority require some form of physician oversight. CONCLUSIONS The role of nurses has expanded in Europe over the last decade, as demonstrated by the adoption of new laws on prescribing rights.
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Affiliation(s)
- Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623, Berlin, Germany.
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, United States of America.
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van den Brink GTWJ, Kouwen AJ, Hooker RS, Vermeulen H, Laurant MGH. An activity analysis of Dutch hospital-based physician assistants and nurse practitioners. HUMAN RESOURCES FOR HEALTH 2019; 17:78. [PMID: 31665010 PMCID: PMC6819603 DOI: 10.1186/s12960-019-0423-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/24/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The physician assistant (PA) and the nurse practitioner (NP) were introduced into The Netherlands in 2001 and 1997 respectively. By the second decade, national policies had accelerated the acceptance and development of these professions. Since 2015, the PA and NP have full practice authority as independent health professionals. The aim of this research was to gain a better understanding of the tasks and responsibilities that are being shifted from Medical Doctors (MD) to PAs and NPs in hospitals. More specifically in what context and visibility are these tasks undertaken by hospital-based PAs and NPs in patient care. This will enable them to communicate their worth to the hospital management. STUDY DESIGN A descriptive, non-experimental research method design was used to collect and analyze both quantitative and qualitative data about the type of tasks performed by a PA or NP. Fifteen medical departments across four hospitals participated. METHODS The patient scheduling system and hospital information system were probed to identify and characterize a wide variety of clinical tasks. The array of tasks was further verified by 108 interviews. All tasks were divided into direct and indirect patient care. Once the tasks were cataloged, then MDs and hospital managers graded the PA- or NP-performed tasks and assessed their contributions to the hospital management system. FINDINGS In total, 2883 tasks were assessed. Overall, PAs and NPs performed a wide variety of clinical and administrative tasks, which differed across hospitals and medical specialties. Data from interviews and the hospital management systems revealed that over a third of the tasks were not properly registered or attributed to the PA or NP. After correction, it was found that the NP and PA spent more than two thirds of their working time on direct patient care. CONCLUSIONS NPs and PAs performed a wide variety of clinical tasks, and the consistency of these tasks differed per medical specialty. Despite the fact that a large part of the tasks was not visible due to incorrect administration, the interviews with MDs and managers revealed that the use of an NP or PA was considered to have an added value at the quality of care as well to the production for hospital-based medical care in The Netherlands.
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Affiliation(s)
- G T W J van den Brink
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Master Programs, HAN University of Applied Sciences, PO box 6960, 6503 GL, Nijmegen, The Netherlands.
| | - A J Kouwen
- Radboud University Medical Center, PVI, Nijmegen, The Netherlands
| | - R S Hooker
- Health Policy Analyst, Ridgefield, WA, United States of America
| | - H Vermeulen
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G H Laurant
- Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- HAN University of Applied Sciences, Institute of Nursing Studies, Nijmegen, The Netherlands
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Nurse practitioners leading the way: An exploratory study on the added value of nurse practitioners in outpatient care in the Netherlands. J Am Assoc Nurse Pract 2019; 32:800-808. [PMID: 31584508 DOI: 10.1097/jxx.0000000000000307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many Dutch nurse practitioners (NPs) work together with physicians and specialized nurses (SNs) in outpatient clinics, although the latter have questioned the added value of NPs in the outpatient clinic. Clarification of the distinction between and the added value of both nursing professions in relation to each other could lead to optimal use of the unique competencies of each type of nurse. PURPOSE To explore NPs' perspectives on their added value in relation to SNs in the outpatient clinic. METHODOLOGICAL ORIENTATION Data were analyzed by Braun and Clarke's thematic analysis. The CanMEDS competences were used to identify the NPs' comments about their practice. SAMPLE Twelve semi-structured interviews were conducted with NPs from two hospital settings. CONCLUSIONS The added value of NPs was most evident in: nursing leadership, integrating care and cure and performing an expert level of nursing expertise, and competencies in science. To optimize their roles, NPs and SNs need to make all team members aware of their unique competences and promote role clarification. IMPLICATIONS FOR PRACTICE This study provides barriers in barriers that influence optimal positioning of NPs within the interdisciplinary team, stresses the importance of discussion on the optimal skill mix within the interdisciplinary team, and describes the NPs' leadership role because this is the encompassing link between the main competencies of their practice. Addressing and overcoming these findings could improve the NPs' positioning and effective collaboration within (the outpatient clinic's) interprofessional teams.
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Commentaries on health services research. JAAPA 2019. [DOI: 10.1097/01.jaa.0000558235.22122.c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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