School of Nursing, University of Victoria, PO Box 1700, STN CSC, Victoria, British Columbia, V8W 2Y2, Canada.
BMC Nurs. 2013 Jan 23;12:1. doi: 10.1186/1472-6955-12-1.
At the time of this study (2009) the role of the nurse practitioner was new to the province of British Columbia. The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members' acceptance for the new role.
The purpose of the study was to explain the process of nurse practitioner role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. The technique of explanation building was used in data analysis. Three primary health care settings in one health authority in British Columbia were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents.
The results demonstrate the complexity of implementing a new role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the nurse practitioner was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the nurse practitioner was facilitated by team members' prior knowledge of either the role or the individual nurse practitioner. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role.
The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the nurse practitioner is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the nurse practitioner to fulfill role expectations. Implications for research, policy, practice and education are discussed.
在本研究进行之时（2009 年），护士从业者这一角色在不列颠哥伦比亚省还属新生事物。省政府将该角色的推行职责赋予各卫生当局。而卫生当局的管理人员，他们中的许多人对这一角色并不熟悉，需负责确定该角色的实际需求、确定该角色的运作方式，并获得团队成员对这一新角色的认可。
本研究旨在解释护士从业者角色推行的过程，以及确定可能增强推行过程的因素。采用具有嵌入式分析单位的解释性单案例研究。在数据分析中使用了解释构建技术。不列颠哥伦比亚省一个卫生当局的三个主要基层医疗保健环境被有目的地选取。数据来源包括对参与者（n=16）和关键文件的半结构式访谈。
研究结果表明，在不熟悉新角色的环境中推行新角色非常复杂。研究结果表明，在推行过程的早期以及在护士从业者被聘用之后，团队成员需要澄清角色意图，他们希望得到上级卫生当局管理人员的协助。团队成员对角色或个别护士从业者的先前了解有助于接受护士从业者。社区卫生保健提供者需要参与推行过程，随着他们对角色的了解和认识，他们的接受程度也会提高。
研究结果表明，意图、参与和接受这三个概念的相互关系影响着推行过程以及护士从业者在该环境中的运作方式。如果没有这三个概念中的任何一个，不仅推行工作会变得困难，而且护士从业者也难以满足角色期望。对研究、政策、实践和教育的启示进行了讨论。
