Monique Mavronicolas_Research Project

8/21/2019 Monique Mavronicolas_Research Project

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A Question of Quality:

What impact do Nurse Practitioners have on Primary Health Care

in the UK?

Monique Mavronicolas

Date: March 2015

Word count: 6747

Abstract


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This study ais to access !urse "ractitioners# $erce$tions o% their

i$act on $riary health care and ho& their contribution to the health

service industry in'uences the quality o% $atient care( )n order to *ain

insi*ht into the health service industry in the +nited ,in*do and the

issues &hich have increasin*ly dra&n edia attention and concoitantly

$ut the s$otli*ht directly on the edical %raternity- a cohort o% seven

quali.ed !urse "ractitioners &ere invited to $artici$ate in this research

study( /esearch .ndin*s in this study stron*ly su**est that eective

ana*eent o% care standards requires care%ul strate*ic $lannin*

bet&een the boardroo and the bedside( A$art %ro health and social

care onitorin* *rou$s onitorin* service standards- ore $roactive

strate*ies need to be set in $lace to $revent a isatch in sills bet&een

su$$ly and deand( +nder sourcin* o% counity and social care

services reains a concern and overnent investent in the current

nursin* &or%orce needs to be a $riority(

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Table o% 3ontents

Abstract(( 2

Table o% 3ontents

Acno&led*eents(( 4

1( )ntroduction( 5

1(1 ac*round(( 5

1(2 /esearch Ais 5

1( utline o% 3ha$ters( 6

2( 8iterature /evie&( 7

2(1 Methodolo*y

72(2 !ursin* shorta*es and the i$act on "atient 3are

( 92( The role o% !urse "ractitioners co$ared to eneral "ractitioners

(( 12(4 )$rovin* service delivery in "riary ealthcare

152(5 Discussion

( 16( /esearch Methodolo*y

((

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(1 )ntroduction

1;(2 /esearch Desi*n

(( 1;( /esearch Methods

( 19((1 /esearch )nstruent

19((2 indin*s

254(1 )ntroduction

254(2 ?uality o% >rontline "atient 3are

( 254( !urse "ractitioner#s relation to eneral "ractitioners

( 2;4(4 Discussion

( 295( 3onclusion and /ecoendations

( 05(1 /esearch 8iitations

( 15(2 indin*s

(( 1

4


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5( )$lications o% the /esearch >indin*s

(( 25(4 ,ey /ecoendations

5(5 Areas %or >uture /esearch

(

/e%erences

( 4 A$$endi@ ) A$$endi@ ))

(( 7B

;

3onsent >ors

(( 40

Acno&led*eents

) &ould lie to than the study res$ondents &ho oered their tie and

invaluable insi*ht to&ards this research study(

A s$ecial thans also to =ast


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Chapter 1 !ntroduction

1.1 Background

=ver since the decrease in deand %or the services o% *eneral

$ractitioners C"#s- $articularly in Western countries- the dynaic o%

$atient care has had an interestin* shi%t and %ocused on nursin* sta( >or

this reason- as$ects o% care usually $rovided by "#s have eant that

nurses have had to undertae a ore s$ecialist role es$ecially- %or

e@a$le- in the routine ana*eent o% chronic diseases( De$endin* on

the co$le@ity o% $atient care needed- level o% trainin* o% the nurse- as

&ell as the de*ree o% autonoy- care ay be $rovided by a nurse

$ractitioner C8aurant et al( 2004(

o&ever- &ith a very notable decline in nursin* nubers in the

+nited ,in*do resultin* %ro nuerous %actors such as $oor strate*ic

decisions and bud*et cuts- any o% the older and ore e@$erienced

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nurses have had to be recalled to lend their clinical e@$ertise and hel$

train a youn* and ine@$erienced nursin* &or%orce(

1.2 Research Aims

The study &ill tae the %or o% e$irical research( Due to the

constraints o% the siEe o% this sall qualitative study- the sa$le *rou$ o%

intervie&ees &ill $rovide data &hich &ill be liited to the $erce$tions o%

these intervie&ees(

The ai o% this research study is to assess !urse "ractitioner#s

$erce$tions o% $riary health care in the +nited ,in*do &ith a vie& to

their contribution to the health service industry and &hether in their vie&-

this has any i$act on the quality o% service delivery in $atient care(

These ais &ill be o$erationalised by eans o% the %ollo&in* s$eci.c

obFectives:

)( to identi%y !urse "ractitioner#s $erce$tions o% the quality o%

$riary health care in the +, ))( to identi%y the $erce$tions o% &hat i$act their role as health

care $roviders has on $riary health care in the +, )))( to identi%y and e@aine the challen*es &hich !urse "ractitioners

%ace re*ardin* service delivery in $riary health care

>ro e@ainin* the data *enerated by this research- it is ho$ed that the

outcoe o% this study &ill shed li*ht on $ossible *a$s in the $ublic health

services(

1.3 Outline of Chapters

7


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The literature revie& &hich $roceeds this cha$ter- hi*hli*hts the

state o% the health services in the +nited ,in*do and the $ressures

%acin* the !


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)))( What are the best &ays %or enablin* !" to i$rove on their

$riary care service delivery and $rovide a %or&ard looin*

strate*yG

To address the .rst research question- the .rst $art o% the literature

revie& &ill $ur$osely discuss the issue o% nursin* su$$ly and deand

issues- other&ise no&n as &or%orce *a$s- &hich $resently aect !<

or*anisations and the consequential eect on $atient care(


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When selectin* a$$ro$riate literature- ey&ords or search ters

should be used &hen locatin* use%ul in%oration %or the revie& o%

literature CAdler 3lar 2011( )n search %or related literature relevant to

this study- the %ollo&in* ey search &ordsHters &ere used in this study:

Inurse $ractitioner#- Iadvanced nurse $ractitioner#- I$riary health care#-

Inurse $ractitioners &orin* in $riary care#- Inational health services

+,#- and Iadvanced nursin* in the +,#( The online databases o% J


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revie&ed Fournals &as subFected to critical a$$raisal( >inally- in%oration

*athered %ro the acadeic $ublications and %e& selected $eerBrevie&ed

Fournals- &ere subdivided and %orally &ritten under the %ollo&in* ey

thees:

2.2 Nursing shortages and the impact on atient Care

)n the +nited orin* the cornerstone o% =n*land#s !ational ealth


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errors( This &as %ound to be the case o% 11 hi*h incoe countries

surveyed- &hich include >rance-


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%ollo&in* ethods: salaries- ca$itation and %eeB%orBservice( To i$rove the

quality o% the services available to the $atients o% the !


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outside o% ritain &ith re$ortedly one in .ve nurses e$loyed in +,

hos$itals coin* %ro


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!urse "ractitioners- by virtue o% their &or sco$e and

res$onsibilities- are o%ten described as Iautonoous# and Iinde$endent#

$ractitioners( y i$lication this also eans that &hen it coes to !"#s

actions- they are $ro%essionally and $ersonally accountable( >or e@a$le-

should !"#s decide not to undertae $atient care in a certain &ay- they

ust be *iven the autonoy and authority to ae those decisions &hich

are in the best interests o% their $atient( 3onsequentially- this hi*hli*hts

!"#s vulnerabilities based on the %act that they are ana*in* clinical

uncertainty( o&ever in ters o% vicarious liability- !"#s are no ore

vulnerable to clais o% liability than say- other nurses or even eneral

"ractitioners- as it is usually the e$loyer &ho is sued in the instance o%

thin*s *oin* &ron* CCompetencies in nursing$ Nurse practitioners 2005(

)n a study on $riary care and the i$act o% nurse $ractitioners on

the &orload o% *eneral $ractitioners- the randoiEed controlled trial

revealed that by incor$oratin* nurse $ractitioners into *eneral $ractice

teas- did not initially reduce the &orload o% *eneral $ractitioners(

bFective and subFective &orloads &ere easured( This eant that- at

least in the short ter- there &as evidence to su**est that !"#s are used

as su$$leents rather than substitutes &hen it coes to care *iven by

"#s C8aurant et al( 2004(

!urse "ractitioners or


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C"( This eans that they &or &ith rather than %or "#s &ith the

e$hasis bein* on collaboration rather than substitution( )n ters o%

quali.cations- they &ill have had a iniu trainin* o% a de*ree level(

Additionally- they &ill have been trained and are able to deonstrate

sills &hich include $hysical assessent- edical consultations-

dia*nosis- health $rootion and be able to su$$ort s$eci.c areas o% lon*

ter conditions &hich could include astha and diabetes( The /3!

aes the recoendation %or those &antin* to becoe !"#s to

undertae study and trainin* to at least an honours de*ree level &hile

Advanced !urse "ractitioners CA!"- are ty$ically able to oer the sae

services o% a nurse $ractitioner- but in addition &ill have a $rescribin*

quali.cation as &ell as a Master#s de*ree C!< 3areers(

)n a systeic $eer revie& o% an international study on nurse

$ractitioners- data revealed that there &as lo& to oderate evidence to

su**est that des$ite $atient health outcoes bein* siilar %or nurse

$ractitioners and doctors- the quality o% care and $atient satis%action &as

hi*her in relation to nurse $ractitioners co$ared &ith doctors( The study

also revealed that there &as oderate quality evidence to su**est that

nurse $ractitioners undertoo ore investi*ations and had lon*er

consultations co$ared &ith doctors( The study &as o% nurse

$ractitioners &orin* in $riary healthcare involvin* initial assessent

and autonoous ana*eent o% $atients C


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)n ters o% $ers$ectives on &or%orce *a$s- the /3! $redicts that

the %all in nubers o% nurses in the +,- could reach as uch as 2; $er

cent C100-000 by 2022 Cuchan and


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2., -iscussion

There are nuerous incentives and onitorin* bodies in $lace in the

+, &ith the $ur$ose o% i$rovin* the quality and availability o% national

health care services( Additionally- %undin* has increased to try and

accoodate deands in health care( o&ever- the costBeective

shi%tin* o% $ublic health services has hi*hli*hted certain vulnerabilities

&hile leavin*- es$ecially the $riary care sector- over stretched and

under nursed( This has had a ne*ative i$act- es$ecially in an

increasin*ly hi*hli*hted and assessed cate*ory o% $atient e@$erience(

The need to i$rovin* service delivery in $riary health care has

there%ore becoe equally i$ortant( The role o% !urse "ractitioner in an

ever d&indlin* &or%orce thus becoes a %ocal $oint &hen assessin* the

quality o% $atient care and ho& eectively !"#s are $rovidin* a

su$$leentary service to "#s(

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Chapter & $esearch 'ethodolo(y

3.1 *ntroduction

This cha$ter discusses the ethod used in the research study(


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e@$erience o% the researcher durin* the entire $rocess o% co$letin* this

study(

3.2 Research -esign

A qualitative research desi*n &as chosen- because it allo&s the

researcher to *ather a ore inBde$th descri$tion concernin* the

$ro%essional e@$eriences o% each quali.ed research intervie&ee( y usin*

a seiBstructured research intervie& schedule- the e$irical research

study desi*n- $ur$osely ade use o% data obtained %ro intervie&s &ith

senior nurse $ractitioners(

Ty$ically- the use o% seiBstructured research intervie& ethods-

heavily rely on the interB$ersonal sills o% the research intervie&er(

There%ore- it is essential on the $art o% the intervie&er to .rst establish a

ra$$ort &ith his or her $ros$ective research intervie&ees( )n this study-

re*ardless o% a*e- *ender and nationality- quali.ed research intervie&ees

&ere identi.ed throu*h the researcher#s $ro%essional net&or( olt C2010

notes that intervie&s can be done either %aceBtoB%ace or via tele$hone( )n

line &ith this- the research intervie&s &ere undertaen %aceBtoB%ace &ith

each o% the research intervie&ees- by tele$hone or throu*h the use o%


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candidate( There%ore- the use o% this $articular $riary research

technique- allo&s each o% the research intervie&ees to disclose their o&n

$ersonal thou*hts and %eelin*s re*ardin* the research questions ased in

the actual intervie&s Colt- 2010( Aside %ro ain* I%ree 'o research

intervie&s $ossible- the researcher &ill be able to *ather $ure subFective

res$onses C3ohen- Manion Morrison 2011 and valid in%oration

concernin* the $ersonal e@$eriences o% each research intervie&ee CTaylor

>rancis- 201(

The seiBstructured research intervie& schedule in this study- &as

desi*ned under %our aFor classi.cations as %ollo&: bac*round-

$ers$ectives on quality and i$act o% care- &orBrole challen*es and

lastly- career $ro*ression(


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study- data *eneration &ould only be required %ro intervie&in* $riary

care !urse "ractitioners C!" &orin* at an advanced level o% $ractice P

other&ise no&n as advanced nurse $ractitioners or A!" P and not include

/e*istered !urses C/! or ealth 3are Worers C3W or ealth 3are

Assistants C3A( Additionally- the research res$ondents &ere required to

be e$loyed in the $ublic health care syste(

The $riary ode o% counication used to *enerate data %ro

the research cohort- &as the use o% %aceBtoB%ace intervie&s- althou*h

&here this &as not $ossible-


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3areH

=er*ency!urse

"ractitioner

de$artent-contribute to&ardssta induction$ro*raes

care

>aceBtoB>ace)ntervie&

MaceBtoB>ace)ntervie&

aceBtoB>ace)ntervie&

M


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$atients $resentin*&ith acute andchronic edicalconditions in both a&alBin and booed

routinea$$ointentssettin*

3.3.2 &ampling

nce a list o% $otential candidates &as located- all o% &ho &ere

either currently e$loyed in $ublic health services or at soe sta*e in

their career- their $ro%essional e@$ertise and overall $ro.le &as care%ully

revie&ed by the researcher- be%ore sendin* each o% the $otential research

candidates an introductory eBail e@$lainin* the ain $ur$ose o% the

study- the reasons %or bein* invited to $artici$ate in the study- includin*

other research ethics required as a candidacy $reBrequisite(

3.3.3 -ata Analysis

As %ar as data and analysis o% research .ndin*s is concerned- it is

deeed ethical not to %abricate- %alsi%y or coit any si*ns o% $la*iaris

durin* the course o% the research study CMarsden Wri*ht- 2010( To

avoid the lielihood o% any such $erils- the *atherin* o% $riary data %ro

the research intervie&s- &as analyEed to*ether &ith the *athered

secondary data(

3.) thical Considerations

A nuber o% ethical considerations *overnin* the study- &ere

hi*hli*hted in the research desi*n( "rior to coencin* research- all the

ethical considerations &ere %ully adhered to( The rule o% conduct

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associated &ith in%ored consent- $ertains to $rovidin* each o% the

$otential research intervie&ees- &ith the choice o% voluntary $artici$ation

in the research intervie& Cde Raus- 2002( As such- it &as ethical to

$rovide each o% the $otential research intervie&ees- &ith the o$tion o%

choosin* &hether or not to $artici$ate in this study( )n res$ect to the

$rinci$les o% in%ored consent- each o% the research intervie&ees &ere

in%ored about the ain $ur$ose o% the study- the o$tion o% research

intervie& $artici$ation- includin* their ri*ht to &ithdra& Cu$ to the $oint

&here the data is analysed &ithout the need to $rovide a reason %or

&ithdra&al( Additionally- each o% the research res$ondents &ere in%ored

that any questions they ay have at any sta*e o% the research study-

&ould be ans&ered in %ull by the researcher C


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)t is soeties the case that third $arties are interested in usin* the

*athered data $resented in an acadeic study( This &ould understandably

$resent data usa*e considerations in accordance &ith re*ulation- in the

case o% this $articular studyin accordance &ith the Data "rotection Act

C199;( As such- $artici$ants &ere in%ored about the lielihood o% the

recorded data $rovided in this study- bein* archived or ade available %or

%uture research studies( =@ce$t %or the subFective res$onse %ro each o%

the research intervie&ees- the research to$ic o% this study &as not

deeed sensitive in nature( To avoid $la*iaris in any %or- all

in%oration %ound in $eerBrevie&ed Fournals- acadeic boos or relevant

or*aniEational &ebsites- &ere $ara$hrased( 8ie&ise- a$$ro$riate

re%erencin* &as observed throu*hout this study(

3., Conclusion

The research res$ondents &ere %ound to be very hel$%ul and

%orthcoin* durin* the intervie& $rocess( The atos$here durin* the

intervie&s &as rela@ed and the intervie&ees o%ten added ore

in%oration to the questions than &as needed by the researcher(

Additionally- &here there &ere technical eleents that the researcher &as

not %ailiar &ith or unsure o%- such as certain terinolo*y- the

res$ondents al&ays too tie to elaborate %urther(

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Chapter 2 $esearch 3indin(s

4(1 )ntroduction

The seiBstructured intervie& schedule can be vie&ed under

A$$endi@ )) o% this study( ?uestion 1 P o% the intervie& schedule are

suarised in table 1(1 listed above in the $revious cha$ter( The research

.ndin*s based on the reainin* intervie& questions- &hich are detailed in

the $roceedin* subsections o% this cha$ter- are *rou$ed into t&o ain

sections- naely quality o% %rontline $atient care- %ollo&ed by a section on

!"#s relation to eneral "ractitioners( The reason %or includin* this last

section- &as to *au*e !"#s $erce$tions o% ho& they %elt about their

Isu$$leentary# roles in a healthcare environent &here o%ten ties-

des$ite their assistance to *eneral $ractitioners- in $ractice they $er%or

any o% the sae %unctions(

4(2 ?uality o% >rontline "atient 3are

2;


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)n res$onse to 4uestion num-er 2- relatin* to the !"#s $erce$tions

on the quality o% $riary health care in the +,- the aFority o% the

research res$ondents %elt that &hile $riary health care &as

co$aratively better than in ost other hi*h incoe countries- there

&ere very clear challen*es to $rovidin* a consistent standard o% health

care( )ntervie& res$ondent nuber %elt that the !ursin* and Mid&i%ery

3ouncil set out clear enou*h *uidelines and &as $roactive enou*h &ith

their hearin*s and outcoes $rocesses %or dealin* &ith restrictions-

sanctions and sus$ension orders in investi*atin* co$laints re*ardin*

nurses( /es$ondent nuber 5 and 6 %elt that the education and trainin* o%

+, nurses &as o% a suLciently hi*h enou*h standard and that this

%actored into the quality o% care &hich nurse $ractitioners &ere able to

$rovide to their $atients(

Question num-er 5 o% the intervie& schedule ased the intervie&

res$ondents about ho& they $erceived their i$act on the $ublic health

syste in ters o% $rovidin* $atient care( The res$onses &ere

understandably ore diverse and individually subFective than the ans&ers

to question nuber 4( "artici$ant 2 and 7 %elt that they had a sense o%

$ersonal $ride in $rovidin* a hi*h level o% $atient care and that because

they &ere surrounded by a su$$ortive tea o% collea*ues- this ade it a

$leasure to do their Fobs and it eant that their $atients acno&led*ed

their level o% care( /es$ondent nuber 1 entioned that %rontline $ublic

health- althou*h o%ten challen*in* and eotionally deandin*- &as a

re&ardin* $ro%ession to be in althou*h her concern &as that &ith the

bud*et cuts ade- $atients &ho are in $ain %or e@a$le and requirin*

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edication to relieve their $ain- have to be re%used that edication based

on the %act that it is too e@$ensive( The res$ondent there%ore %elt that it is

issues lie this that ae it diLcult as a nurse $ractitioner- to %eel lie one

is havin* a $ositive i$act on %rontline health care( "artici$ants - 4 and 5

all shared a siilar vie&$oint in that they %elt that they &ere

overe@tended in their $ractices and there%ore could not tae on ore

duties( This there%ore had a ne*ative i$act on their contribution in ters

o% $rovidin* $atient care as they had to ee$ their consultations to a bare

iniu(

The research res$ondents &ere observably interested in ans&erin*

4uestion 6- &hich ased about $rovidin* %eedbac on challen*es &hich

they encountered in their &or roles( There &as a unanious a*reeent

aon* res$ondents concernin* the challen*in* as$ect o% their &or roles

as nurse $ractitioners( The interestin* outcoe o% the res$onses in

relation to question 6- &as that the res$ondents all a*reed that their

advanced education and trainin* enabled the to eectively co$e &ith

the clinical co$le@ities o% their &or roles( o&ever- the nuber o%

challen*es $resent in their &or environents- &ere o%ten either directly

or indirectly a result o% %actors outside the sco$e o% their roles as $riary

health care $ractitioners( >or e@a$le- $artici$ant 2 e@$ressed that &hat

&as soeties challen*in* about their role as a nurse $ractitioner and

&hich bore an indirect i$act on the level o% service they &ere able to

$rovide to $atients- &as the obsession &ith eetin* tar*ets set by

ana*eent and that this consequently contributed to&ards overall sta

stress levels( "artici$ant 5 e@$lained that &hat they %ound challen*in* &as

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soeties seein* clear evidence o% cases involvin* hos$ital $atients &ho

had been ne*lected- not by their o&n %aily or carers- but by other

*eneral nursin* sta( )t &as %urther e@$lained that in their vie&- a $resent

and %uture challen*e- is the deand %or nurses and that the *ro&in*

elderly $o$ulation has a direct bearin* on this need( "artici$ant 6 had a

%airly siilar res$onse to $artici$ant 5( They e@$lained that &hat they

%ound challen*in* &as the disconcertent o% seein* $atients &ho

soeties *et lost and con%used in the syste and then havin* to return

%or a$$ointents( This is seen $articularly &here there is ore than one

s$ecialist treatin* the $atient or lac o% coordination o% other services

$rovided( "artici$ants 1- and 7 coented on overcro&din* in A=

&ards( "artici$ant added that they see the $revalence o% $atients &illin*

to &ait %or hours in A= si$ly because they cannot *et a quic enou*h

a$$ointent &ith their o&n "#s or they &ould rather &ait in A= to see

soeone %ace to %ace than to s$ea to a nurse $ractitioner over the

$hone( The consensus aon* the intervie& $artici$ants &as that this

inclination seen in certain $atients- &hile understandable to a de*ree- only

created ore co$lications both %or eer*ency sta teas as &ell as

those A= $atients &ho le*itiately needed eer*ency edical

treatent( o&ever- $artici$ant 7 concluded that the alternative advice to

$atients to stay a&ay %ro A= unless their lives are at ris- is si$ly

ludicrous advice(

4( !urse "ractitioner#s relation to eneral "ractitioners

1


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When the res$ondents &ere ased 4uestion 7- &hether they %elt

that the $ay *a$ bet&een advanced nurses and *eneral $ractitioners &as

too bi*- the ans&ers $rovided by the res$ondents also revealed an insi*ht

into the subtle nuances o% their &orin* relationshi$s &ith " sta( >or

e@a$le res$ondent nuber 5- &ho holds the $osition o% 8ead !urse

"ractitioner in their $articular &or settin*- e@$lained that "#s and !"#s

are siilar in that they both dia*nose and treat $atients &ith acute and

chronic diseases( The level o% clinical autonoy &hich is also aorded to

!"#s- brin*s the in line &ith "#s and allo&s the to $ractice a %ull sco$e

o% edicine( >or this reason- as res$ondent 5 e@$lains- !"#s are receivin*

ore Fob oers than ever be%ore and it also eans that their $ay is

increasin*( /es$ondent 2 e@$lained that it &as !"#s &ho &ere boostin*

the deand %or edical services( While their roles in ters o% $riary

health care- are su$$leentary co$ared to "#s- res$ondent 2 still did

not thin that the $ay dierence &as o% suLciently hi*h variances to

&arrant dissatis%action on the $art o% !"#s( The reainder o% the

res$ondents held siilar vie&$oints to question 7(

When 4uestion 8 &as $osed to the research res$ondents- the

aFority e@$ressed their satis%action &ith the quali.cations they had

attained in advanced nursin*( /es$ondent 5 e@$lained that !"#s are

already at an advanta*e over their avera*e re*istered nurse counter$arts(

)n %act- as they e@$lained- &ith soe !"#s &ho hold a Master#s de*ree-

they even have an advanta*e over soe edical students as those !"#s

&ith advanced de*rees have already studied and $assed any o% the

courses required by students studyin* to&ards becoin* a doctor(

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/es$ondent e@$lained that becoin* a !" holds a sli*ht advanta*e in

that- es$ecially in ters o% $riary health care- one is able to start

$racticin* sooner &hich also increases your earnin* $otential and $ayin*

o any student loans sooner( iven the choice to start over a*ain- they

&ould de.nitely not hesitate to %ollo& the !" study route over the "

route( /es$ondent 4 %elt that !"#s and "#s have a dierent coitent

des$ite !"#s sharin* any o% the sae duties as a "( !"#s study to

dia*nose and cure $atients- &hereas "#s study to dia*nose and cure

diseases( iven the o$$ortunity to study %urther- res$ondent 4 &ould

s$ecialise as an Advanced !urse "ractitioner( /es$ondent 4#s res$onse

*enerally set the tone %or all the res$ondents in that- *iven their current

&or roles and quali.cations- they &ere content &ith reainin* !"#s( The

contentent %actor stes %ro their &or advanta*es- such as ease o%

e$loyability- &or autonoy and %rontline coitent to $atient care

and &or satis%action(

4(4 Discussion

While it is challen*in* to ascertain &hether the $erce$tions o% a

sall crossBsection o% !urse "ractitioners re$resented in this study-

accurately ebody the $erce$tions o% the &ider $ro%ession o% $riary care

$ractitioners- &hat the data has revealed- are t&o $oints:

>irstly- that the res$ondents are *enerally in a*reeent &ith re*ards to

vie&s on the status o% $riary health care in the +,(


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Chapter 5 Conclusion and $ecommendations

5(1 /esearch 8iitations

The sall crossBsection o% !urse "ractitioners co$osin* the study

cohort in this $a$er- des$ite the $revalence o% !"#s in ost health care

settin*s in the +,- is re'ective o% the co$aratively sall nuber o% !"#s

not only $resently e$loyed in the +nited ,in*do- but also &orld&ide(

This $rovided an increased challen*e in accuulatin* the total nuber o%

res$ondents available to tae $art in this study and a lar*er test sa$le

&ould there%ore $rovide i$ortant validatin* data in uch needed %uture

research on the sae to$ic( Additionally- the e@istence o% a ared

abi*uity in de.nin* &hat a !urse "ractitioner is in ters o% their role and

%unction- added to the liited e@istin* data available %or $ur$oses o% and

use in this study(

5(2 indin*s

The aFority o% !urse "ractitioners intervie&ed- &ere con.dent in

the %act that their education and trainin*- enabled the &ith a certain

$ro.ciency to $rovide a *ood level o% $riary health care( There &as a

consensus aon* the res$ondents that the $roble &ith $riary health

care in the +,- &as &ith ana*in* to $rovide a consistent standard o%

4


35/44

health care across the board( Additionally- the consensus aon*

res$ondents &as that their &or roles $resented a nuber o% varyin*

challen*es( These challen*es ran*ed %ro the re$orted obsession &ith

eetin* tar*ets set by ana*eent- bein* overe@tended in their

$ractices &hich reduced the consultation ties &ith $atients- to dealin*

&ith the overcro&din* o% A= &ards( The data su$$lied by the

res$ondents there%ore irrors a nuber o% the $oints raised in the

literature revie& in cha$ter t&o o% this study( indin*s

5


36/44

While there are nuerous %actors &hich attribute to the &orB

$ressures and deands on nurse $ractitioners- such as hos$ital

overcro&din* and isuse o% A= centres- the star reality is that &here

there is an a*in* +, $o$ulation- *iven the current $ressures on the !uture /esearch

As the data revie&ed in this study revealed- includin* the $ersonal

insi*ht oered by the study res$ondents- the services o% eer*ency nurse

$ractitioners are increasin*ly in deand( ased on the overburdenin* o%

6


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hos$itals and $ublic resources in the +, &hich includes the shorta*e o%

eneral "ractitioners- continued studies into =!"#s and outcoes related

to sa%ety and quality o% $atient care- is needed(

$eferences

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38/44

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!hat is primary health care"5 n(d( +niversity o% ristol: 3entre %or

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2015U(

A$$endi@ ) P "artici$ant 3onsent >or

=ast


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Tel: 0177772611

Pro9ect .itle: A ?uestion o% ?uality: What i$act do !urse "ractitioners

have in "riary ealth 3are in the +,G

Name of $esearcher: Monique Mavronicolas

Please initial -o

1( ) con.r that ) understand the $ur$ose o% the study( Throu*h e@$lanation-) have had the o$$ortunity to consider the in%oration- as

questions andhave had these ans&ered satis%actorily(

2( ) understand that y $artici$ation is voluntary and that ) a %ree to&ithdra& at any tie &ithout *ivin* any reason- u$ to the $oint&hen thedata is analysed(

( ) understand that data collected durin* the study- ay be looed at byindividuals %ro the =ast


43/44

Question 1: What is your 9o- role?

Question ": What are your ma9or responsi-ilities?

Question &: Ho% many years have you -een in service?

Question 2: What are your vie%s on the 4uality of care in the UK?

Question 5: What do you perceive to -e your impact on the pu-lic

health system in terms of providin( patient care?

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Question 6: What are the challen(es %hich you face in your %or;

role?

Question 7:

Documents

Monique Mavronicolas_Research Project