Nurse practitioners: Better care for patients

- May 16, 2014

In conjunction with Ryerson University, Dal researchers recently released the results of a joint intensive study on the nurse practitioner role (“NPs”), just in time for National Nursing Week (May 12-18).

“Interprofessional collaboration is important to patient/client care,” explains Kathleen MacMillan, director of the School of Nursing and the study’s co-principal investigator. “What our study demonstrated was the integral role that NPs play in developing and maintaining the collaboration across a patient’s health-care team.”

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 “value-add”

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.

“We wanted to see the ‘value-add’ of the NP role,” says Dr. MacMillan. “Our 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.”

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.

“It is the proactive, comprehensive approach of NPs to patients that makes the difference in outcomes” 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 – NP stream. Dal’s 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’t replace MDs, “but they do provide significant value-added as a different kind of provider in the system,” says Dr. van Soeren.

“It is not about doing the same role [as MDs], but rather taking a different approach,” adds Dr. MacMillan. “The nursing background and ‘lens’ provides a different kind of care that acts as a bridge among providers and with patients.”

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’ 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.

“It 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,” says Dr. MacMillan.


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