The future role of practice nurses

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Background: Practice nurses in Australia could collaborate more with general practitioners to complement the services provided. However, for this to occur it is important to determine whether practice nurses have the opportunity and support they need to increase their decision-making about the organisation and delivery of patient care. Aim: The aim of this research is to determine if there are actual and/or potential opportunities for practice nurses to participate in collaborative care and increase their decision-making about patients’ care. Methods: A sequential mixed-methodology was used. The first quantitative study was designed to determine relationships between opportunities for decision-making by practice nurses in their work place, support from colleagues and supervisors, and opportunities for the development of skills and abilities. An opportunistic sample of practice nurses (n= 160) employed in the State of New South Wales was asked to complete a 60-item self-administered online questionnaire, the ‘Job Content Questionnaire’. Internal reliability and consistency was determined by α coefficients and confirmatory factor analysis. Sequential regression models tested hypothesised relationships between independent and dependent variables. The second qualitative study was designed to develop an in-depth and contextual understanding of the results presented by the questionnaire. A purposive sample of practice nurses (n= 15) employed in New South Wales, who had not participated in Study 1, was recruited. These practice nurses were asked to participate in an interview guided by the findings of the first study. The interview data were thematically analysed. The results of each study were triangulated. Results: Results from Study 1 and Study 2 indicated that practice nurses have the opportunity to make decisions about the organisation and delivery of care to patients, and are making a distinct contribution to the care of patients in general practice. While they are collaborating with general practitioners within the structural limitations on their role, their ability to contribute to care is dependent on their capacity to build relationships and demonstrate the financial viability of their role. Discussion and conclusions: Workforce shortages and increased demands for care, particularly for people with chronic disease, will challenge the primary care sector. Practice nurses are well placed to expand their practice to lead the management of patients with chronic disease and to pursue more independent and perhaps, autonomous clinical practice. However, there is a need for a clear articulation of a professional frame of reference for this role, which will require alterations to the funding and the traditional structure of general practice. It must also be demonstrated that practice nurse-led care is both safe and effective.
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