KRISTEN KESSINGERUNIVERSITY OF CENTRAL FLORIDA

NGR 6273

Enhancing Nurse Practitioner Image, Role

Development, and Autonomy through

Collaboration

Scope: History and Background of the Issue

Nurse practitioners can provide needed support for our changing healthcare system and increased medical needs of our country. Several barriers stand in the way of allowing NPs to practice to the

full extent of their training and education. With fast changes in our complex health care system,

quality care is critical in providing cost effective care that meets the needs of our aging country.

NPs face role confusion from both their personal experience and in working with other health care professionals. Lack of familiarity with role, lack of respect, and inconsistent

attitudes towards NP practice can prevent NPs from practicing to their full extent (Burgess& Purkis, 2010).

Scope: History and Background of the Issue

Poor collaboration between NPs and other healthcare team members can greatly impact:- quality of care- professional role

development and satisfaction- the image of the nurse

practitioner profession. Poor collaboration can lead

to serious issues in regards to safety, continuity of care, and communication with patients and families (Faith Donald, 2009).

Scope: History and Background of the Issue

Barriers to collaboration (Clarin, 2007)

- Lack of knowledge about NP role and scope of practice

- Poor physician attitude- Lack of respect- Poor communication - Patient and family

reluctance of NP role

Identification of the Problem

Nurse practitioners need to make changes to practice in effort to:- enhance their image in the healthcare community- improve role clarity within the healthcare team -practice to the full extent of their scope in order to provide quality care in our complex healthcare system.

Role of the nurse leader With increased use of NPs in the

medical field, NPs need to step up and also take a leadership role within the healthcare team.

Giving NPs a voice they can feel empowered to:

-change healthcare policy- impact their professional image-work towards increased autonomy.

Enhancing autonomy and collaboration among health care professionals can help to advance NP role integration (Burgess & Purkess, 2010).

Alternative Solutions

Increase NP autonomy and enhance role image through legislative efforts to remove practice and supervisory restrictions on NPs. Autonomous practice can help meet changing health care

needs and enhance professional identity (Pruitt et al., 2002).Media campaigns help generate publicity and

improve visibility for the advanced nursing role (Newland, 2007).

NP residency programs and mentors help ease transition and generate role clarity for new practitioners (Goudreau et al., 2011; Hollinger-Smith & Murphy, 1998)

Solution and Rationale Enhancing collaboration

between NPs, physicians, and other disciplines is a great strategy to increase quality of care and promote NP image and autonomy. This notion of collaboration

needs to be differentiated from "supervision" of NPs by MDs.

Collaboration involves high degrees of assertiveness and cooperativeness (Maylone et al., 2009). All team members are valued for their unique contributions to the decision making process (Burgess & Purkis, 2010).

Solution and Rationale

Burgess and Purkis (2010) found that collaboration was foundational to everyday practice and aided the advancement and integration of NP roles. Helped NPs to explore new practice approaches, enhance

professional partnerships, and foster their autonomy. Aided in bridging the professions of nursing and medicine,

allowing NPs to realize their distinct role and establish professional identity and role clarity.

Increased capacity to provide quality care and try innovative interventions.  It can also help to engage jointly in political action that can help improve healthcare

Solution and Rationale

Maylone et al. (2009) finds that collaboration between NPs and physicians improves the quality and cost of healthcare and also enhances professional satisfaction.

Physicians who work with NPs agree that NPs help attract new patients and can provide most primary care. Patients are willing to receive care from NPs and help to free up physicians time and add a positive dimension to the office (Street & Cossman, 2009).

In the long term care setting, NP and physician collaboration and lead to a more efficient use of physician time. Collaborative teams have shown a reduction in hospitalizations and cost savings, an increase in resident knowledge, access to care, and better relationships between nurses and physicians (Faith Donald et al., 2009).

Solution and Rationale

Benefits of Collaboration (Clarin, 2007):

- Decreased length of stay- Improved medical

management and health maintenance with decrease in unnecessary office visits

- Better comprehensive patient education

- Greater patient satisfaction

Implementation Plan

To help the NP profession move forward and actualize a better healthcare system, collaborative efforts are required by nurses, MDs, policymakers, and the public. Continual education of colleagues on the importance

of collaboration is critical (Burgess & Purkis, 2010).Many MDs often feel they are legally liable

for the care NPs provide. Providing autonomous NP practice can help alleviate

this barrier (Schadewaldt et al., 2013).

Implementation Plan

Factors that can help foster collaboration include: -working in close proximity with partners -taking time for regular meetings

-having a positive attitude towards collaboration-official recognition of NP role, including legal protection.

Better information strategies about the NP role and an earlier exposure to inter-professional education can also help (Schadewaldt et al., 2013).

A written collaborative contract can allow for open discussion and outline duties/roles so that role overlap does not occur. Use of clinical practice guidelines can also help to clarify roles (Faith Donald et al., 2009).

Implementation Plan

In the long term care setting Faith Donald et al. (2009) found that NPs were rarely included in rounds and quarterly reviews of patient progress. Allowing NPs to be a part of this can greatly enhance collaborative efforts.

Most important, for those professionals who have achieved successful relationship, they should serve as mentors for future physician, NP dyads and help them towards attaining a successful collaboration (Faith Donald et al., 2009).

Implementation Plan

Strategies to help improve from Clarin (2007):- Provide formal orientation regarding NP/physician

collaboration-Expose medical students early on to advanced

practice nursing role- Strive for uniform NP education, certification, and

scope of practice- Use of integrated collaboration models- Interdisciplinary rounds with NP involvement- Monthly team meetings that discuss collaboration

and hold team members accountable for their part.

Plan for Evaluation

Faith Donald et al. (2009) propose annual evaluations of NP and physicians. This allows the dyad to discuss what is going well and

areas of improvement. A strategic plan can then be devised to strengthen

the relationship. In regards to collaboration in a long term

care setting, the idea of a "teaching nursing home" that attracts medical students can help facilitate collaboration between NPs and MDs (Faith Donald et al., 2009).

Plan for Evaluation

To evaluate the importance of collaboration further research can look into exploring the effect of the collaborative relationship on patient care outcomes. Perhaps, studies can be done assessing patient satisfaction to determine effectiveness of NP/physician collaboration (Clarin, 2007).

References

Bailey P, Jones L, Way D. (2006). Family physician/nurse practitioner: stories of collaboration. Journal Of Advanced Nursing. February 15, 2006;53(4):381-391.

Burgess, J., & Purkis, M. (2010). The power and politics of collaboration in nurse practitioner role development. Nursing Inquiry, 17(4), 297-308. doi:10.1111/j.1440-1800.2010.00505.x

Clarin, O. A. (2007). Strategies to overcome barriers to effective nurse practitioner and physician collaboration. Journal for Nurse Practitioners. 3(8):538-548. 

Donald, F., Mohide, E., DiCenso, A., Brazil, K., Stephenson, M., & Akhtar-Danesh, N. (2009). Nurse practitioner and physician collaboration in long-term care homes: survey results. Canadian Journal On Aging, 28(1), 77-87. doi:10.1017/S0714980809090060

Goudreau, K. A., Ortman, M., Moore, J. D., Aldredge, L., Helland, M. K., Fernandes, L. A., & Gibson, S. (2011). A Nurse Practitioner Residency Pilot Program. Journal Of Nursing Administration, 41(9), 382-387. doi:10.1097/NNA.0b013e31822a7315

Hallas, D., Butz, A., & Gitterman, B. (2004). Attitudes and beliefs for effective pediatric nurse practitioner and physician collaboration. Journal Of Pediatric Healthcare, 18(2), 77-86.

Hollinger-Smith, L., & Murphy, M. (1998). Advanced practice. Implementing a residency program for the acute care nurse practitioner. MEDSURG Nursing, 7(1), 28.

References

Maylone, M., Ranieri, L., Quinn Griffin, M. T., McNulty, R., & Fitzpatrick, J. J. (2011). Collaboration and autonomy: Perceptions among nurse practitioners. Journal Of The American Academy Of Nurse Practitioners, 23(1), 51-57. doi:10.1111/j.1745-7599.2010.00576.

Newland, J. (2007). Tinseltown Nurses and Public Perception. Nurse Practitioner. p. 5. Pruitt, R. H., Wetsel, M., Smith, K. J., & Spitler, H. (2002). How do we pass NP

autonomy legislation?. Nurse Practitioner, 27(3), 56. Putnam, J., Ikeler, S., Raup, G., & Cantu, K. (2014). There's no "I" in team: evaluating

nurse-physician collaboration. Nursing Management, 45(1), 10-13. doi:10.1097/01.NUMA.0000440636.71636.ea

Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2013). Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care -- an integrative review. BMC Family Practice, 14(1), 132-142. doi:10.1186/1471-2296-14-132

Street, D., & Cossman, J. S. (2010). Does familiarity breed respect? Physician attitudes toward nurse practitioners in a medically underserved state. Journal Of The American Academy Of Nurse Practitioners, 22(8), 431-439. doi:10.1111/j.1745-7599.2010.00531