In conjunction with Ryerson University, Dal researchers recently released the results of a joint intensive study on the nurse practitioner role (鈥淣Ps鈥�), just in time for National Nursing Week (May 12-18).
鈥淚nterprofessional collaboration is important to patient/client care,鈥� explains Kathleen MacMillan, director of the and the study鈥檚 co-principal investigator. 鈥淲hat our study demonstrated was the integral role that NPs play in developing and maintaining the collaboration across a patient鈥檚 health-care team.鈥�
The study, examining patients in both hospitals and long-term care settings in Ontario, took place over three years. Its Dal leads, Dr. MacMillan and Mary van Soeren, are both RNs who hold PhDs. Dr. MacMillan previously worked for the Ontario Health Ministry during the policy implementation of the NP role, while Dr. van Soeren has been heavily involved in national policy and research on the integration of NPs into the health care system.
Examining the 鈥渧alue-add鈥�
The study looked at three core elements of quality care: patient-centred care, evidence-informed practice and interprofessional collaboration. Data were collected from 149 NP surveys (self report), 52 individual interviews with key health care provider team members and careful observation of 24 NPs and their interactions with others during their typical work days. Patient receiving care from NPs were surveyed at two points during the study related to key outcomes of care, including how often they required a follow up health care visit.
鈥淲e wanted to see the 鈥榲alue-add鈥� of the NP role,鈥� says Dr. MacMillan. 鈥淥ur aim was to foster understanding of what NPs are actually doing in acute and long-term care settings and to understand the impact of the role as it contributes to interprofessional collaboration for the purpose of providing high-quality, safe patient care.鈥�
The study also found a corresponding relationship between the autonomy granted to nurse practitioners and increased quality of patient care: the greater the autonomy of NPs (for example, the authority to admit, discharge, change plans of care), the more timely the care and the better the patient outcomes.
鈥淚t is the proactive, comprehensive approach of NPs to patients that makes the difference in outcomes鈥� explains Dr. van Soeren, who is also the associate director of undergraduate programs in the School of Nursing.
Nurse Practitioners are registered nurses (RNs), who obtain a Masters in Nursing 鈥� NP stream. Dal鈥檚 program admits about 15 RNs every year to the program.
Armed with their additional education and professional designation as a NP from the College of Registered Nurses of Nova Scotia, these advanced practice nurses can diagnose, order tests, prescribe drugs and carry out procedures normally restricted to physicians. They don鈥檛 replace MDs, 鈥渂ut they do provide significant value-added as a different kind of provider in the system,鈥� says Dr. van Soeren.
鈥淚t is not about doing the same role [as MDs], but rather taking a different approach,鈥� adds Dr. MacMillan. 鈥淭he nursing background and 鈥榣ens鈥� provides a different kind of care that acts as a bridge among providers and with patients.鈥�
As an example, Dr. MacMillan explains NPs are pivotal in coordinating interdependent tasks. For example, the physiotherapist may collaborate with the NP around the ordering of appropriate pain medication so the patient can participate more effectively in physiotherapy.
Informing decision makers
In Nova Scotia, there are about 140 NPs, whereas in Ontario there are 2,400. That means, per capita, Nova Scotia has about 30 per cent less NPs than Ontario.
Moving forward, the investigators plan to share the information gained from the study widely to decision makers in institutional settings and government policy makers. They hope to support advocacy to maximize the nurse practitioners鈥� legislated role in Ontario and in Nova Scotia. For example, while the Ontario government has approved regulation for NPs to admit and discharge patients from hospitals (although some institutions still do not allow this), NPs do not have this authority yet in Nova Scotia.
鈥淚t is important for health-care decision makers to know how the NP role enhances collaboration, evidence-informed practice and patient-centred care so they address restrictions on NP practice that prevent them from making a greater contribution,鈥� says Dr. MacMillan.