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Nurse practitioners as a solution to transformative and sustainable health services in primary health care: A qualitative exploratory study

Published:December 22, 2016DOI:https://doi.org/10.1016/j.colegn.2016.12.001

      Abstract

      Objective

      To consider the alignment of the Nurse Practitioner (NP) role in NZ with the goals and aspirations of the many countries facing challenges to maintaining health service delivery and reducing health disparities.

      Methods

      Data was collected as a component of a larger institutional ethnography but for this paper was thematically analysed to answer specific questions about NP practice alignment with a transformative service agenda. Interviews were conducted with NPs and management staff in private general practices, health clinics operated by District Health Boards (DHBs), and not for profit health providers, including Primary Health Organisations (PHOs), and community/indigenous health clinics.

      Results

      The findings demonstrate that NPs have competently taken on a range of previously deemed medical tasks but also practice congruently with a nursing approach to practice. They provide comprehensive person and family centred care, focussing on seamless and integrated service delivery. Because their role is often regarded as only a substitute for medicine they are often employed in ways that limit their full potential.

      Conclusion and implications

      NPs can provide a service that closely replicates the goals of the NZ Health Strategy (2016) and the current aspirations of many countries concerned to provide sustainable health services.

      Keywords

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      References

        • Adams S.
        • Carryer J.
        • Wilkinson J.
        Institutional ethnography: An emerging approach for health and nursing research.
        Nursing Praxis in New Zealand. 2015; 31: 18-26
        • American Academy of Family Physicians
        Primary care for the 21st century.
        2012 (Retrieved from)
        • Bauer U.E.
        • Briss P.A.
        • Goodman R.A.
        • Bowman B.A.
        Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA.
        The Lancet. 2014; 384: 45-52https://doi.org/10.1016/S0140-6736(14)60648-6
        • Bauer J.C.
        Nurse practitioners as an underutilized resource for health reform: Evidence-based demonstrations of cost-effectiveness.
        Journal of the American Academy of Nurse Practitioners. 2010; 22: 228-231https://doi.org/10.1111/j.1745-7599.2010.00498.x
        • Blakely T.
        • Woodward A.
        Ecological effects in multi-level studies.
        Journal of Epidemiology and Community Health. 2000; 54: 367-374https://doi.org/10.1136/jech.54.5.367
        • Browne A.J.
        • Tarlier D.S.
        Examining the potential of nurse practitioners from a critical social justice perspective.
        Nursing Inquiry. 2008; 15: 83-93https://doi.org/10.1111/j.1440-1800.2008.00411.x
        • Budzi D.
        • Lurie S.
        • Singh K.
        • Hooker R.
        Veterans’ perceptions of care by nurse practitioners, physician assistants, and physicians: A comparison from satisfaction surveys.
        Journal of the American Academy of Nurse Practitioners. 2010; 22: 170-176https://doi.org/10.1111/j.1745-7599.2010.00489.x
        • Busfield J.
        ‘A pill for every ill’: Explaining the expansion in medicine use.
        Social Science and Medicine. 2010; 70: 934-941https://doi.org/10.1016/j.socscimed.2009.10.068
        • Carryer J.
        • Yarwood J.
        The nurse practitioner role: Solution or servant in improving primary health care service delivery.
        Collegian. 2015; 22: 169-174https://doi.org/10.1016/j.colegn.2015.02.004
        • Carryer J.
        • Gardner G.
        • Dunn S.
        • Gardner A.
        The core role of the nurse practitioner: Practice, professionalism and clinical leadership.
        Journal of Clinical Nursing. 2007; 16: 1818-1825
        • Carryer J.
        • Doolan-Noble F.
        • Gauld R.
        • Budge C.
        New Zealand patients’ perceptions of chronic care delivery.
        Journal of Integrated Care. 2014; 22: 71-80https://doi.org/10.1108/JICA-12-2013-0048
        • Chulach T.
        • Gagnon M.
        Working in a ‘third space’: A closer look at the hybridity, identity and agency of nurse practitioners.
        Nursing Inquiry. 2016; 23: 52-63https://doi.org/10.1111/nin.12105
        • Commission on Social Determinants of Health
        Closing the gap in a generation: Health equity through action on the social determinants of health.
        2008 (Retrieved from)
        • Currie G.
        • Lockett A.
        • Finn R.
        • Martin G.
        • Waring J.
        Institutional work to maintain professional power: Recreating the model of medical professionalism.
        Organization Studies. 2012; 33: 937-962https://doi.org/10.1177/0170840612445116
        • Dierick-van Daele A.T.M.
        • Metsemakers J.F.M.
        • Derckx E.W.C.C.
        • Spreeuwenberg C.
        • Vrijhoef H.J.M.
        Nurse practitioners substituting for general practitioners: Randomized controlled trial.
        Journal of Advanced Nursing. 2009; 65: 391-401https://doi.org/10.1111/j.1365-2648.2008.04888.x
        • Dierick-van Daele A.T.M.
        • Steuten L.M.G.
        • Metsemakers J.F.M.
        • Derckx E.W.C.C.
        • Spreeuwenberg C.
        • Vrijhoef H.J.M.
        Economic evaluation of nurse practitioners versus GPs in treating common conditions.
        British Journal of General Practice. 2010; 60: 28-33
        • Donald F.
        • Kilpatrick K.
        • Reid K.
        • Carter N.
        • Bryant-Lukosius D.
        • Martin-Misener R.
        • DiCenso A.
        Hospital to community transitional care by nurse practitioners: A systematic review of cost-effectiveness.
        International Journal of Nursing Studies. 2015; 52: 436-451https://doi.org/10.1016/j.ijnurstu.2014.07.011
        • Friedberg M.W.
        • Hussey P.S.
        • Schneider E.C.
        Primary care: A critical review of the evidence on quality and costs of health care.
        Health Affairs. 2010; 29: 766-772https://doi.org/10.1377/hlthaff.2010.0025
        • Goodwin N.
        • Smith J.
        • Davies A.
        • Perry C.
        • Rosen R.
        • Dixon A.
        • Ham C.
        Integrated care for patients and populations: Improving outcomes by working together.
        The King’s Fund & Nuffield Trust, London, UK2012
        • Hollinghurst S.
        • Horrocks S.
        • Anderson E.
        • Salisbury C.
        Comparing the cost of nurse practitioners and GPs in primary care: Modelling economic data from randomized trials.
        British Journal of General Practice. 2006; 56: 530-535
        • Horrocks S.
        • Anderson E.
        • Salisbury C.
        Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors.
        British Medical Journal. 2002; 324: 819-823
        • King A.
        The primary health care strategy.
        Ministry of Health, Wellington, NZ2001
        • Kooienga S.A.
        • Carryer J.B.
        Globalization and advancing primary health care nurse practitioner practice.
        Journal for Nurse Practitioners. 2015; 11: 804-811https://doi.org/10.1016/j.nurpra.2015.06.012
        • Kruk M.E.
        • Porignon D.
        • Rockers P.C.
        • Van Lerberghe W.
        The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives.
        Social Science and Medicine. 2010; 70: 904-911https://doi.org/10.1016/j.socscimed.2009.11.025
        • Marmot M.
        • Bell R.
        Fair society, healthy lives.
        Public Health. 2012; 126: S4-S10https://doi.org/10.1016/j.puhe.2012.05.014
        • Marmot M.
        • Friel S.
        • Bell R.
        • Houweling T.A.
        • Taylor S.
        Closing the gap in a generation: Health equity through action on the social determinants of health.
        The Lancet. 2008; 372: 1661-1669https://doi.org/10.1016/S0140-6736(08)61690-6
        • Martínez-González N.A.
        • Djalali S.
        • Tandjung R.
        • Huber-Geismann F.
        • Markun S.
        • Wensing M.
        Substitution of physicians by nurses in primary care: A systematic review and meta-analysis.
        BMC Health Services Research. 2014; 14https://doi.org/10.1186/1472-6963-14-214
        • Martin C.M.
        • Peterson C.
        The social construction of chronicity—A key to understanding chronic care transformations.
        Journal of Evaluation in Clinical Practice. 2009; 15: 578-585
        • Martin-Misener R.
        • Harbman P.
        • Donald F.
        • Reid K.
        • Kilpatrick K.
        • Carter N.
        • DiCenso A.
        Cost-effectiveness of nurse practitioners in primary and specialised ambulatory care: Systematic review.
        BMJ Open. 2015; 5https://doi.org/10.1136/bmjopen-2014-007167
        • Maten-Speksnijder A.
        • Grypdonck M.
        • Pool A.
        • Meurs P.
        • van Staa A.L.
        A literature review of the Dutch debate on the nurse practitioner role: Efficiency vs. professional development.
        International Nursing Review. 2014; 61: 44-54https://doi.org/10.1111/inr.12071
        • Matheson D.
        • Loring B.
        Health inequities are rising unseen in New Zealand.
        New Zealand Medical Journal. 2011; 124: 8-10
        • Ministry of Health
        New Zealand health strategy: Future direction.
        Ministry of Health, Wellington, NZ2016
        • Ministry of Health
        New Zealand health strategy: Roadmap of actions 2016.
        Ministry of Health, Wellington, NZ2016
        • Pirret A.M.
        • Neville S.J.
        • La Grow S.J.
        Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: A comparative study.
        International Journal of Nursing Studies. 2015; 52: 716-726https://doi.org/10.1016/j.ijnurstu.2014.08.009
        • Ploeg J.
        • Kaasalainen S.
        • McAiney C.
        • Martin-Misener R.
        • Donald F.
        • Wickson-Griffiths A.
        • Taniguchi A.
        Resident and family perceptions of the nurse practitioner role in long term care settings: A qualitative descriptive study.
        BMC Nursing. 2013; 12https://doi.org/10.1186/1472-6955-12-24
        • Quinlan E.
        • Robertson S.
        The communicative power of nurse practitioners in multidisciplinary primary healthcare teams.
        Journal of the American Academy of Nurse Practitioners. 2013; 25: 91-102https://doi.org/10.1111/j.1745-7599.2012.00768.x
        • Rasanathan K.
        • Montesinos E.V.
        • Matheson D.
        • Etienne C.
        • Evans T.
        Primary health care and the social determinants of health: Essential and complementary approaches for reducing inequities in health.
        Journal of Epidemiology and Community Health. 2011; 65: 656-660
        • Smith D.E.
        Institutional ethnography: A sociology for people.
        Altamira Press, Lanham, MD2005
        • Stanik-Hutt J.
        • Newhouse R.P.
        • White K.M.
        • Johantgen M.
        • Bass E.B.
        • Zangaro G.
        • Weiner J.P.
        The quality and effectiveness of care provided by nurse practitioners.
        Journal for Nurse Practitioners. 2013; 9 (e413): 492-500https://doi.org/10.1016/j.nurpra.2013.07.004
        • Starfield B.
        Primary care: An increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012.
        Gaceta Sanitaria. 2012; 26: 20-26https://doi.org/10.1016/j.gaceta.2011.10.009
        • Stephens C.
        • Porter J.
        • Nettleton C.
        • Willis R.
        Disappearing, displaced, and undervalued: A call to action for Indigenous health worldwide.
        Lancet. 2006; 367: 2019-2028https://doi.org/10.1016/S0140-6736(06)68892-2
        • Swan M.
        • Ferguson S.
        • Chang A.
        • Larson E.
        • Smaldone A.
        Quality of primary care by advanced practice nurses: A systematic review.
        International Journal for Quality in Health Care. 2015; 27: 396-404https://doi.org/10.1093/intqhc/mzv054
        • Toomath R.
        Fat science: Why diets, exercise don’t work—And what does.
        Auckland University Press, Auckland, NZ2016
        • Villeneuve M.J.
        Yes we can! Eliminating health disparities as part of the core business of nursing on a global level.
        Policy, Politics, and Nursing Practice. 2008; 9: 334-341https://doi.org/10.1177/1527154408328661
        • West M.A.
        • Lyubovnikova J.
        Illusions of team working in health care Journal of Health.
        Organisation and Management. 2013; 27 ([10.1108/14777261311311843]): 134-142
        • Wilkinson J.
        Places for nurse practitioners to flourish: Examining third sector primary care.
        Australian Journal of Advanced Nursing. 2012; 29: 36-42
        • Williams S.
        • Martin P.
        • Gabe J.
        The pharmaceuticalisation of society? A framework for analysis.
        Sociology of Health and Illness. 2011; 33: 710-725https://doi.org/10.1111/j.1467-9566.2011.01320.x
        • Woodward A.
        • Blakely T.
        The healthy country? A history of life & death in New Zealand.
        Auckland University Press, Auckland, NZ2014
        • World Health Organization
        Global status report on noncommunicable diseases 2014: Attaining the nine global noncommunicable diseases targets; a shared responsibility.
        2014 (Retrieved from)
        • Xue Y.
        • Ye Z.
        • Brewer C.
        • Spetz J.
        Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review.
        Nursing Outlook. 2016; 64: 71-85https://doi.org/10.1016/j.outlook.2015.08.005