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. 2017 Aug 23;17(1):589.
doi: 10.1186/s12913-017-2548-x.

Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study

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Collaboration in teams with nurse practitioners and general practitioners during out-of-hours and implications for patient care; a qualitative study

Mieke van der Biezen et al. BMC Health Serv Res. .

Abstract

Background: Increasingly, nurse practitioners (NPs) are deployed in teams along with general practitioners (GPs) to help meet the demand for out-of-hours care. The purpose of this study was to explore factors influencing collaboration between GPs and NPs in teams working out-of-hours.

Methods: A descriptive qualitative study was done using a total of 27 semi-structured interviews and two focus group discussions. Data was collected between June, 2014 and October, 2015 at an out-of-hours primary care organisation in the Netherlands. Overall, 38 health professionals (GPs, NPs, and support staff) participated in the study. The interviews were audio-taped and transcribed verbatim. Two researchers conducted an inductive content analysis, involving the identification of relevant items in a first phase and clustering into themes in a second phase.

Results: The following four themes emerged from the data: clarity of NP role and regulation, shared caseload and use of skills, communication concerning professional roles, trust and support in NP practice. Main factors influencing collaboration between GPs and NPs included a lack of knowledge regarding the NPs' scope of practice and regulations governing NP role; differences in teams in sharing caseload and using each other's skills effectively; varying support of GPs for the NP role; and limited communication between GPs and NPs regarding professional roles during the shift. Lack of collaboration was perceived to result in an increased risk of delay for patients who needed treatment from a GP, especially in teams with more NPs. Collaboration was not perceived to improve over time as teams varied across shifts.

Conclusion: In out-of-hours primary care teams constantly change and team members are often unfamiliar with each other or other's competences. In this environment, knowledge and communication about team members' roles is continuously at stake. Especially in teams with more NPs, team members need to use each other's skills to deliver care to all patients on time.

Keywords: Collaboration; Inter-professional relations; Nurse practitioner; Nursing; Out-of-hours care; Primary care; Skill mix.

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Conflict of interest statement

Authors’ information

MB, MSc, RN, PhD student; MW, PhD professor of health services research and implementation science; LP, PhD, MPH, RN, FAAN, assistant Professor of Nursing; RB, MSc, project coordinator; ML, PhD, professor organisation of health care and services.

Ethics approval and consent to participate

Ethics committee approval was obtained from a university (CMO-nr 2014–1409). Researchers followed the Netherlands Code of Conduct for Academic Practice [42]. All participants gave their consent for recording the interviews and data was coded and processed anonymously.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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