Meta Analysis on The Role of Nurse Practitioner
Meta Analysis on The Role of Nurse Practitioner
Meta Analysis on The Role of Nurse Practitioner
Introduction
Healthcare renewal includes a focus on transitioning from siloed professional practices to care by synergistic groups of healthcare professionals working to their full scope of practice across the healthcare system (Romanow, 2002). Research findings regarding interprofessional (IP) collaboration and teamwork suggest these strategies improve use of clinical resources, increase access to healthcare, reduce conflict between healthcare professionals, and improve patients’ care quality, safety and outcomes (Closson & Oandasan, 2007; Frank & Brien, 2008; Zwarenstein, Goldman, & Reeves, 2009). However, there are limited data on setting specific strategies that augment or limit team development and process; specifically how collaboration occurs within hospital teams remains unclear (O’Leary et al., 2010).
The nurse practitioner (NP) role within hospital teams is of interest because of the unique dual role within traditional medical practice (such as prescribing and diagnosing), and nursing (such as physical care and psychosocial support) supports the ability to cross this professional boundary (Kleinpell, 2005; Litaker et al., 2003; Sidani & Doran, 2010). Findings from several studies indicate the NP role is pivotal in hospital IP team work (Desborough, 2012; van Soeren, Hurlock-Chorostecki, & Reeves, 2011; Williamson, Twelvetree, Thompson, & Beaver, 2012).
There is no clear evidence of how the NP role enhances IP team work in spite of indication from team members and NPs that this role is effective within the team context (Kilpatrick et al., 2012; van Soeren et al., 2011).
To explore this phenomena, a two-phase study was completed using team members’ and NPs’ perceptions of how the NP role was enacted within the IP team. The aim of the study was to critically explore HB NP role value. Two research questions were posed: (1) what is the hospital team members’ shared perception of the value of the NP role working within hospital teams, and how does this relate to the NP shared perception? (2) How do the shared perceptions relate to the socio-political influences and position of the NP role within hospital teams?
Phase one of the study explored the team member shared perception of NP role value within hospital teams. A team perspective framework emerged from the first phase of the study and revealed that the HB NP role value meaning for team members was linked to three categories and 13 sub-categories (Hurlock-Chorostecki, Forchuk, Orchard, Reeves, & van Soeren, 2013). The most valued category was that of a ‘‘labour saver’’. The remaining two categories described expectations to evolve practice for the team, and centrality of the HB NP role in holding patient care together. This framework presented new knowledge of team member expectations and understanding of HB NP practice. Phase two explored the NP shared perception of their role value, examined how the team shared perception related to the shared NP perception, and exposed how these relate to the socio-political influences of power that position the NP role within the teams. Described in this paper are the results of the NP
Correspondence: Dr. Christina Hurlock-Chorostecki, PhD, NP, Western University, London, Ontario, Canada. E-mail: churlock@uwo.ca
shared perspective, relating this with the existing team perspective framework, and situating these within the hospital IP team setting.
Methods
Charmaz’s (2006) approach to constructivist grounded theory was used to explore data from NP interviews and integrate the findings with team member results previously reported (Hurlock- Chorostecki et al., 2013). This approach holds values and methods that differ from the classic grounded theory. Because this approach is interpretive, explores how and why meanings and actions are constructed, values the researcher’s view, explores power influences, and positions emerging theory with current theory it was deemed most appropriate for this study (Charmaz, 2000, 2006). Western University Research Ethics Board and the Lawson Clinical Research Impact Committee provided ethical approval for this study.
Data collection
NPs employed within Ontario hospitals were invited to participate in group or individual interviews. Email invitations were circulated by key hospital stakeholders and the NP professional organization. NP inclusion criteria consisted of: registration with the College of Nurses of Ontario (2012) in the extended class of nursing (inclusive of all NP specialty certificates); current employment within a hospital team in the role of NP working with patients, and employed in the current NP role for greater than one year.
