Abstract
Objectives
To identify the barriers and facilitators associated with the implementation of the nurse practitioner (NP) role in Ontario’s public health units (PHUs), the NPs’ job satisfaction, and the relationship between NP job satisfaction and practice dimensions.
Methods
This descriptive study involved a postal survey of all NPs (N=29) working in Ontario PHUs.
Results
Twenty-eight (96.5%) NPs completed the survey. The facilitators to role implementation most often identified by the NPs were management support, the NPs’ knowledge of the PHU programs, and access to PHU programs for their clients. The barriers most often cited were being the only NP working in the PHU, inadequate salary, and lack of coverage when the NP was away. When working with community physicians, the most common facilitators were the trust shown by physicians when making shared decisions and physician respect for the NP. The most common barriers were the unwillingness of specialist physicians to accept referrals from the NP and physicians’ lack of understanding of the role. Overall, the NPs were satisfied with working in the PHU, satisfied with their collaborative relationship with physicians and minimally satisfied with their salaries.
Conclusion
NPs have recently been introduced in PHUs in Ontario. A number of factors have facilitated role integration. At the same time, a number of barriers to their role implementation have been identified and if addressed, can contribute to the optimal utilization of this role in PHUs.
Key words: Nurse practitioners, public health, primary health care, role implementation, job satisfaction
Résumé
Objectifs
Définir les éléments qui entravent et ceux qui favorisent l’implantation du rôle des infirmières praticiennes (IP) dans les bureaux de santé publique de l’Ontario, la satisfaction professionnelle des IP et le lien entre la satisfaction professionnelle et divers aspects de l’exercice de la profession.
Méthode
Étude descriptive avec enquête postale auprès de toutes les IP (N=29) travaillant dans les bureaux de santé publique de l’Ontario.
Résultats
Vingt-huit IP (96,5 %) ont répondu au sondage. Les éléments le plus souvent cités comme favorisant l’implantation du rôle des IP étaient l’appui de la direction, la connaissance des programmes du bureau de santé publique par les IP et l’accès à ces programmes pour leurs clients. Les obstacles les plus souvent cités étaient le fait d’être la seule IP à travailler dans le bureau, le salaire insuffisant et l’absence de remplaçants pour les IP. Quand les IP travaillent avec des médecins communautaires, les éléments les plus souvent cités comme favorisant leur implantation étaient la confiance manifestée par le médecin dans la prise de décisions partagées et le respect du médecin envers l’IP. Les obstacles les plus courants étaient le refus des médecins spécialistes d’accepter les personnes dirigées par l’IP et le manque de compréhension du rôle des IP par les médecins. Globalement, les IP étaient satisfaites de leur travail dans les bureaux de santé publique, satisfaites de leur collaboration avec les médecins et marginalement satisfaites de leur salaire.
Conclusion
La présence des IP dans les bureaux de santé publique de l’Ontario est récente. Un certain nombre de facteurs ont facilité leur intégration. Simultanément, des obstacles à l’implantation de leur rôle ont été cernés; l’abolition de ces obstacles pourrait contribuer à optimiser l’utilisation des IP dans les bureaux de santé publique.
Mots clés: infirmiers praticiens, santé publique, soins de santé primaires, implantation du rôle, satisfaction professionnelle
Footnotes
Conflict of Interest: None to declare.
References
- 1.Sloan C, Pong R, Rukholm E, Caty S. Nurse Practitioner Workforce Survey and NPAO Electronic Registry Project Report. 2006. [Google Scholar]
- 2.Canadian Nurse Practitioner Initiative. Nurse practitioners: The time is now. 2006. [Google Scholar]
- 3.van Soeren M, Hurlock-Chorostecki C, Goodwin S, Baker E. The primary health care nurse practitioner in Ontario: A workforce study. Can J Nurs Lead-ersh. 2009;22(2):58–72. doi: 10.12927/cjnl.2009.20798. [DOI] [PubMed] [Google Scholar]
- 4.Horrocks S, Anderson E, Salisbury C. Systematic review of whether nurse practitioners working in primary care can provide equivalent care to doctors. Br Med J. 2002;324:819–23. doi: 10.1136/bmj.324.7341.819. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Michel I, Ehrlich A, Lynn-Wright B, Szadkowski M, McFarland V. Nurse Practitioner Cervical Screening Pilot Project Evaluation Report. Toronto, ON: Public Health Research Education and Development Program; 2003. [Google Scholar]
- 6.Snelling S, Ehrlich A, Grafton D, Michel I, MacLean L, McFarland V. Evaluation of the prenatal and postnatal nurse practitioner services initiative: Interim report. Toronto: PHRED; 2005. [Google Scholar]
- 7.Public Health Research EducationDevelopment Program. Evaluation of the Prenatal and Postnatal Nurse Practitioner Services Initiative: Final Report. Sudbury, ON: PHRED; 2006. [Google Scholar]
- 8.Middlesex-London Health Unit. An Overview of the Characteristics of Nurse Practitioners in Public Health Units across Ontario. London, ON: Middlesex-London Health Unit; 2005. [Google Scholar]
- 9.Capacity Review Committee. Revitalizing Ontario’s Public Health Capacity: The Final Report of the Capacity Review Committee. 2006. [Google Scholar]
- 10.IBM Business Consulting Services, McMaster University. Report on the Integration of Primary Health Care Nurse Practitioners into the Province of Ontario: Final Report, 2005. Available at: https://doi.org/www.health.gov.on.ca/english/public/pub/ministry_reports/nurseprac03/nurseprac03_mn.html (Accessed October 10, 2005).
- 11.Green SB, Salkind NJ. Using SPSS for Windows and Macintosh: Analyzing and understanding data. Upper Saddle River, New Jersey: Pearson Prentice Hall; 2005. [Google Scholar]
- 12.Pallant J. SPSS Survival Manual. Buckingham: Open University Press; 2003. [Google Scholar]
- 13.Ontario Ministry of Health. Mandatory Health Programs and Service Guidelines. Toronto: Queen’s Printer for Ontario; 1997. [Google Scholar]
- 14.Ontario Ministry of HealthLong-Term Care. Ontario Public Health Standards. 2008. [Google Scholar]
- 15.Martin-Misener R, Valaitis R. A scoping literature review of collaboration between primary care and public health: A report to the Canadian Health Services Research Foundation, September 30. 2008. [DOI] [PubMed] [Google Scholar]
- 16.Bryant-Lukosius D, DiCenso A, Browne G, Pinelli J. Advanced practice nursing roles: Development, implementation and evaluation. J Adv Nurs. 2004;48(5):519–29. doi: 10.1111/j.1365-2648.2004.03234.x. [DOI] [PubMed] [Google Scholar]
- 17.Mick DJ, Ackerman MH. Advanced practice nursing role delineation in oncology nursing: A role delineation study in acute and critical care: Application of the Strong Model of advanced practice. Heart Lung. 2000;29:210–21. doi: 10.1067/mhl.2000.106936. [DOI] [PubMed] [Google Scholar]
- 18.Sidani S, Irvine D, DiCenso A. Implementation of the primary care nurse practitioner role in Ontario. Can J Nurs Leadersh. 2000;13(3):13–19. doi: 10.12927/cjnl.2000.16302. [DOI] [PubMed] [Google Scholar]