Question 1: evaluation of Structure related to nurse
practitioner service
This is about the extent to which the health facility was
sufficiently ready to incorporate the nurse practitioner role
into delivery of service. Evaluation of Structure drew upon
data from the MDT survey and nurse practitioner interviews.
Perceptions of the multidisciplinary team
Responses to the evaluation of the nurse practitioner role
were positive, with a total mean score of 402 (SD 062)
indicating that 95% of responses overall were either ‘agree’
or ‘strongly agree’. The difference between highest and lowest
mean ranked item was less than 25 points on the fivepoint
Likert scale. The highest ranked item was ‘The nurse
practitioner in my area has a positive impact on patient
care’, with two of the other five highest ranked items also
relating to standards of patient care. The total mean scores
for both subscores were very similar, with the total mean
for the three-item subscore ‘communication and teamwork’
of 410. Analysis of the differences between professional
groups revealed the total mean scores were again very similar,
with the nursing group having the highest mean score
(see Table 2) and allied health the lowest. Otherwise, there
was no discernible pattern to responses aside from the
strongly positive perspective to most aspects of the role
when all nurse practitioner roles were grouped together.
Experience of the nurse practitioners
Team function. Results from nurse practitioner interviews
showed the nurse practitioners perceived their role as a
positive addition overall to the team and its impact on the
service structure. Differences were obvious, however, when
the interviewees discussed individual discipline groups. The
nurse practitioner reports revealed that medical, pharmacist
and allied health clinicians were accepting of the role with
positive and productive working relationships. These
groups reportedly understood the role and how it enhanced
patients’ access to timely care. Conversely, radiographers
were reported as resisting the inclusion of requesting X-ray
in the nurse practitioners’ scope of practice. Furthermore,
difficulty in team functioning for the nurse practitioners
related to other nursing staff. Almost 50% of the nurse
practitioners had negative experiences with their nursing
colleagues. Expressions such as ‘shocked’, ‘disappointed’,
‘saddened’ and ‘surprised’ were common in the narratives.
Conversely, the nurse practitioner data also reported
support and collegiality from nursing.
Service structure. The nurse practitioners reported that
team support was important to the integration of the role
into the service. Perceptions of quality of support included
acceptance or resistance of new work structures, succession
planning and continuing education. The most salient finding
in this area related to the need for more clarity around
the work relationships between other advanced practice
nurses and nurse practitioner roles. This was identified as
problematic with no clear planning on how these roles
would complement and enhance each other in clinical
service. Some participants commented on ‘a battle for
leadership’.