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Integrating nurse practitioners into Canadian emergency departments: a qualitative study of barriers and recommendations

Published online by Cambridge University Press:  21 May 2015

Christine Thrasher  and
Rebecca J. Purc-Stephenson
Christine Thrasher*
Affiliation:
Faculty of Nursing, University of Windsor, Windsor, Ont.
Rebecca J. Purc-Stephenson
Affiliation:
Department of Psychology (PhD Candidate), University of Windsor, Windsor, Ont.
*
Level I Coordinator Collaborative Nursing Program, University of Windsor, Windsor ON N9B 3P4; thrash4@uwindsor.ca

Abstract

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Objective:

The objective of this study was to identify the facilitators and barriers associated with integrating nurse practitioners (NPs) into Canadian emergency departments (EDs) from the perspectives of NPs and ED staff.

Methods:

We conducted 24 semi-structured interviews with key multidisciplinary stakeholders in 6 Ontario EDs to gain a broad range of perspectives on implementation issues. Data were analyzed using a grounded-theory approach.

Results:

Qualitative analysis of the interview data revealed 3 major issues associated with NP implementation: organizational context, role clarity and NP recruitment. Organizational context refers to the environment an NP enters and involves issues related to the ED culture, physician reimbursement system and patient volume. Role clarity refers to understanding the NP's function in the ED. Recruitment issues are associated with attracting and retaining NPs to work in EDs. Examples of each issue using respondent's own words are provided.

Conclusion:

Our study identified 3 issues that illustrate the complex issues involved when implementing NPs in EDs. The findings may inform policy makers and health care professionals in the future development of the role of NPs in Canadian EDs.

Keywords

Nurse practitionerfacilitatorsbarriersimplementationemergency medicine
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 4 , July 2007 , pp. 275 - 281
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Canadian Association of Emergency Physicians. Canadian Association of Emergency Physicians position statement on emergency department overcrowding. The Association. Available:http://www.caep.ca.Google Scholar
2.Ministry of Health and Long-Term Care. Hospital report 2005: emergency department care. Joint Initiative of the Ontario Hospital Association and the Government of Ontario. Toronto (ON): University of Toronto; 2005.Google Scholar
3.Trzeciak, S, Rivers, EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J 2003;20:402–5.CrossRefGoogle ScholarPubMed
4.Vertesi, Les. Does the Canadian Emergency Department Triage and Acuity Scale identify non-urgent patients who can be triaged away from the emergency department? Can J Emerge Med 2004;6:337–42.Google Scholar
5.Brownell, MD, Roos, NP, Roos, LL. Monitoring healthcare reform: a report care approach. Soc Sci Med 2001;52:657–70.CrossRefGoogle Scholar
6.Suschnigg, C. Reforming Ontario’s primary healthcare system: one step forward, two steps back? Int J Health Serv 2001;31:91–103.Google Scholar
7.Pryor, C. Balanced budget act enhances value of physician assistants, nurse practitioners. Health Care Strateg Manage 1999;17:12–3.Google ScholarPubMed
8.Neades, BL. Expanding the role of the nurse in the accident and emergency department. Postgrad Med J 1997;73:17–22.Google Scholar
9.Reay, T, Golden-Biddle, K, Germann, K. Challenges and leadership strategies for managers of nurse practitioners. Journal of Nursing Management 2003;11:396–403.CrossRefGoogle ScholarPubMed
10.Van Soeren, MH, Micevski, V. Success indicators and barriers to acute nurse practitioner role implementation in four Ontario hospitals. AACN Clin Issues 2001;12:424–37.Google Scholar
11.Wilson-Barnett, J. Advanced nursing practice: the impact for managers. J Nurs Manag 1998;6:127–8.Google Scholar
12.Tye, CC, Ross, F. Blurring boundaries: professional perspectives of the emergency nurse practitioner role in a major accident and emergency department. J Adv Nurs 2000;31:1089–96.CrossRefGoogle Scholar
13.Ministry of Health and Long-Term Care. Report on the integration of primary healthcare nurse practitioners into the province of Ontario. Toronto (ON): The Ministry; 2003.Google Scholar
14.Wolf, LD, Potter, P, Sledge, J, et al. Describing nurses’ work: combining quantitative and qualitative analysis. Hum Factors 2006;48:5–14.Google Scholar
15.Neutens, JJ, Rubinson, L. Research techniques for the health sciences. 3rd ed. San Francisco (CA): Benjamin Cummings; 2002.Google Scholar
16.Glaser, B. Basics of grounded theory analysis. Mill Valley (CA): Sociology Press; 1992.Google Scholar
17.Strauss, AL. Qualitative analysis for socialsciences. Cambridge (MA): CambridgeUniversity Press; 1987.Google Scholar
18.Ministry of Health and Long Term Care. Expanded Services for Patients Act. Toronto (ON): The Ministry; 1998.Google Scholar
19.Horrocks, S, Anderson, E, Salisbury, C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. BMJ 2002;324:819–23.CrossRefGoogle ScholarPubMed
20.Hayden, ML, Davies, LR, Clore, ER. Facilitators and inhibitors of the emergency nurse practitioner role. Nurs Res 1982;31:294–9.Google Scholar
21.Genet, CA, Brennan, P, Ibbotson-Wolff, S, et al. Nurse practitioner in a teaching hospital. Nurse Pract 1995;20:47–52, 54.Google Scholar
22.Sakr, M, Kendall, R, Angus, J, et al. Emergency nurse practitioners: a three-part study in clinical and cost effectiveness. Emerg Med J 2003;20:158–63.Google Scholar
23.Sakr, M, Angus, J, Perrin, J, et al. Care of minor injuries by emergency nurse practitioners or junior doctors: a randomized controlled trial. Lancet 1999;354:1321–6.CrossRefGoogle ScholarPubMed