Introduction
The role of Nurse Practitioners has expanded extensively over the past few decades. This has been necessitated by a number of factors ranging from the need to cover the apparent nurse shortage, the reforms in the healthcare sector and the increasing number of Nursing Practitioners which has immensely led to massive power and influence by professional bodies that represent Nurse Practitioners. With the primary need to help overcome the apparent challenges in the healthcare sector especially with the increasing population of patients, as well as the increasing demands for quality of care and new models such as the holistic care approaches there has been an unprecedented and unstoppable will to increase the autonomy and independence of NPs. A host of literature and research studies have focused on exploring the effectiveness of the NPs in the healthcare sector with a view to helping identify the apparent gaps as well as the strengths which can be improved, maintained and integrated in other healthcare sector workforce to help shape a better and reliable future for the sector. This paper will seek to explore a variety of literature to explain the diverse views and findings on the roles of NPs and their effectiveness in the entire system.
Literature Review
1) Donelan, Karen; DesRoches, Catherine M; Dittus, Robert; Buerhaus, Peter. (2013). Perspectives of Physicians and Nurse Practitioners on Primary Care Practice.
In this study, the researchers sought to understand the different perspectives of the physicians and Nurse Practitioners on the role of NPs. The study data from a total of 467 NPs and 505 physicians was used for analysis and description of the attitudinal measures as well as clinical practice and personal characteristics. This was further supplemented by data from a subgroup that comprised of 378 NPs and 209 physicians who had reported that at one time or another in their career they have served in both the role of the NP and the physician. Both the NPs and the physicians agreed by a majority that the NPs should be allowed to practice to the full and best extent of their education and knowledge. However, a majority of the physicians disagreed that the NPs can offer the same quality of service as the physicians. In this view, the researchers as well as the survey results indicate that it is important that the healthcare sector seeks greater innovation to reinforce inter-professional education, curriculum and content and training across primary care settings to demonstrate competence in delivering care. NPs are a developing workforce and more resources and innovations need to be channeled towards this sector to help overcome the myriad of challenges in the healthcare sector.
2) Kilpatrick, Kelly; Lavoie-Tremblay, Melanie; Lamoithe, Lise; Ritchie , Judith. (2013). Conceptual framework of acute care nurse practitioner role enactment boundary work, and perception of team effectiveness.
The introduction of acute care NPs in the patient care process has been regarded as a positive step in helping improve the care process outcomes essentially because of the wide scope of practice they offer. This wide scope of practice is a sure strategy to improve the care process because of the wide knowledge and skill that NPs gain from the curricula and training they undergo especially at specialty levels. However, there were a series of other comprising views which indicated that the introduction of NPs in acute care settings has a negative impact on the quality of care and it is only some particular settings that are favored by such initiative while others may significantly affect the care team effectiveness. In this case therefore, the stakeholders in each particular setting need to learn the impact that the introduction of the NPs in acute care primary settings will have on the clinical outcomes as well as on costs of operation and sustenance.
3) Kilpatrick, Kelly (2013). How do nurse practitioners in acute care affect perception of team effectiveness?
The study also explores the same concepts of the impact of the NPs in the acute care primary settings as has been explored in the study by Kilpatrick et al., (2013). The views of other team members were utilized in assessing the role of NPs and how they impact the outcomes in acute care primary settings. The team members agreed that NPs provide positive impact on the aspects of communication, decision making, cohesion, problem solving, care coordination, cohesion as well as holistic focus on patients and their families. The results also indicated that NPs have a significant and positive impact on the aspects of improving patient-centered as well as family centered care. However, it is agreeable that the in order to fully utilize the role of NPs in primary care settings, there is more work that needs to be done in the diversity of settings.
4) Poghosyan, Lusine; Boyd, Donald; Knutson, Ashley R. (2014). Nurse Practitioner Role, Independent Practice, and Teamwork in Primary Care.
The study focuses on the role of NPs in clinical practice and particularly in primary care settings as well as the level of independence and how it affect their capability in providing optimal service. The study utilized the data from a total of 278 NPs who had completed an online survey, in the results; the 42%of the NPs agreed that they had their won patient panels. Similarly, an audited report of their levels of autonomy and independence posted that they had a higher mean score for increased autonomy and independence as compared to that which is afforded to the team in its entirety. Essentially, with increased autonomy the results indicated that the NPs can ably increase or improve the quality of care and the effectiveness of the care teams. This is in agreement with previous studies that have explored the issue of NPs independence and autonomy and how it impacts on the clinical outcomes.
5) Albers‐Heitner, C. P., Lagro‐Janssen, A. L. M., Joore, M. A., Berghmans, L. C. M., Nieman, F., Venema, P. L., &Winkens, R. A. G. (2011). Effectiveness of involving a nurse specialist for patients with urinary incontinence in primary care: results of a pragmatic multicentrerandomised controlled trial. International journal of clinical practice, 65(6), 705-712. http://www.ncbi.nlm.nih.gov/m/pubmed/21564445/
In this study, the researchers sought to study the specific impact of NPs in normal clinical settings with the choice being the handling of [patient with urinary incontinence. The researchers note that there has been documented substandard care for patients with urinary incontinence despite the efforts placed to help not only in caring for these patients but also for curing their health complications. In their randomized controlled trial, a total of 186 patients were placed in the intervention group which was conducted by trained specialist nurses with provision of standard care while the control group had a total of 198 patients who received care from general practitioners within the same standard care practices. The focus was on determining the impact of NPs in helping reduce severity as well as the impact of UI with analysis conducted using the principles of intention-to-treat. The results indicated significant differences between the two groups in the third month with the intervention group scoring highly in terms of recovery and restoration of patient health. However, there were no differences at one-year linear pattern/trend. This indicates that the integration of NPs with specialty skill in primary care settings could prove a vital element in improving the quality of care and patient outcomes. Similarly, the integration of NPs in clinical practice has a positive effect on the team members since they learn from the coordination and collaboration with these specialty NPs.
6) Dierick-van Daele, A. T., Steuten, L. M., Metsemakers, J. F., Derckx, E. W., Spreeuwenberg, C., &Vrijhoef, H. J. (2010). Economic evaluation of nurse practitioners versus GPs in treating common conditions. British Journal of General Practice, 60(570), e28-e35. http://www.ncbi.nlm.nih.gov/m/pubmed/20040165/
Dierick-van Daele et al. (2010) focus on the comparing the costs of sustenance for NPs in regard to the quality and quantity of service they provide. A total of 15 NPs and 50GPs in fifteen general/ study practice settings were involved in the study. on the other hand, an external group of reference of 17 NPs in five general/study units with no involvement of NOPs were utilized to help develop comparisons. The direct costs covered included consultations on follow-up, resource use, duration of consultations as well as salary costs. Productivity losses were assessed as the outside-the-healthcare-sector costs. NPs indicated to have lower costs in the direct costs as compared to reference practices but in terms of direct costs inclusive of societal perceived costs, there were no significant differences. Salary costs were higher for GPs as compared to NPs. Essentially, the researchers agree that NPs indicated substantial savings along economic perspectives while also affording the bets and optimal skill mix which covers the entirety of needs in primary care.
7) Donald, F., Martin‐Misener, R., Carter, N., Donald, E. E., Kaasalainen, S., Wickson‐Griffiths, A., &DiCenso, A. (2013). A systematic review of the effectiveness of advanced practice nurses in long‐term care. Journal of advanced nursing, 69(10), 2148-2161. http://www.ncbi.nlm.nih.gov/m/pubmed/23527481
The researchers in agreement with the results of the prospective studies that had been conducted within the USA posit that APN had better outcomes in long term care settings. The results indicated that for those long term care facilities that are served by APNs, the rates of depression, pressure ulcers, urinary incontinence, restraint use as well as aggressive and disorderly behaviors were lower as compared to these long term care settings served by general practice nurses. Similarly for those settings served by the APNs, there was a significantly higher probability of the patients meeting their personal goals while the family members reported greater satisfaction. Within this view, the researchers recommend that it is important that the healthcare sector seeks methods that can help integrate the APNs more into the utilization of health services across quality of life improvement, quality of care improvement and ultimately achieving job satisfaction for health care workforce.
8) Schuttelaar, M. L. A., Vermeulen, K. M., &Coenraads, P. J. (2011). Costs and cost‐effectiveness analysis of treatment in children with eczema by nurse practitioner vs. dermatologist: results of a randomized, controlled trial and a review of international costs. British Journal of Dermatology, 165(3), 600-611. http://www.ncbi.nlm.nih.gov/m/pubmed/21692770/
In this study, the researchers sought to compare the costs as well as the cots-effectiveness of NPs again that of the dermatologist in providing care to children with eczema. Within the study it was apparent that family costs and mean annual-healthcare costs were significantly lower with the utilization of the services of the NPs as compared to the dermatologist. In that case, the researchers argue that replacing the services of the dermatologists with the NPs has double benefits at cost-effectiveness and cost-saving while assuring of the same quality and effective treatment even with higher patient satisfaction.
9) Stanik-Hutt, J., Newhouse, R. P., White, K. M., Johantgen, M., Bass, E. B., Zangaro, G., & Weiner, J. P. (2013). The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners, 9(8), 492-500. http://www.sciencedirect.com/science/article/pii/S1555415513004108
The researchers utilized previous research with a total of 37 articles from a possible 27, 993 articles that had been published between 1990 and 2009. These studies were then summarized and categorized into eleven aggregated outcomes. These aggregates were then utilized to compare the outcomes of NPs to that of physicians/ MDs (teams without NPs) with results indicate that the NPs provided better outcomes across the 11 sampled reviews. Within these summaries, there was significant and high level form of evidence indicating similar levels of patient satisfaction, health and functional status, blood pressure indications, number of emergency department hospitalizations and visits as well as mortality and morbidity rates. The researchers agree that NPs are equally as effective in terms of quality of care and life for patients and could prove more economically sustainable than the physicians in primary care provision.
