Kraus Elena, DuBois James M
Department of Obstetrics, Gynecology and Women's Health, Saint Louis University School of Medicine, St. Louis, MO, 63117, USA.
Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO, 63110, USA.
J Gen Intern Med. 2017 Mar;32(3):284-290. doi: 10.1007/s11606-016-3896-7. Epub 2016 Oct 31.
The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate that changes to the laws governing NP practice will engender acrimony between practicing physicians and NPs. However, we lack empirical, descriptive data on how practicing professionals view NP independence in primary care.
The aim of the present study was to explore and describe the attitudes about NP independence among physicians and NPs working in primary care.
A qualitative study based on the principles of grounded theory.
Thirty primary care professionals in Missouri, USA, including 15 primary care physicians and 15 primary care NPs.
Semi-structured, in-depth interviews, with data analysis guided by grounded theory.
Participants had perspectives that were not well represented by professional organizations or the media. Physicians were supportive of a wide variety of NP roles and comfortable with high levels of NP independence and autonomy. Physicians and NPs described prerequisites to NP independence that were complementary. Physicians generally believed that NPs needed some association with physicians for patient safety, and NPs preferred having a physician readily accessible as needed. The theme "knowing your limits" was important to both NPs and physicians regarding NP independence, and has not been described previously in the literature.
NP and physician views about NP practice in primary care are not as divergent as their representative professional organizations and the news media would suggest. The significant agreement among NPs and physicians, and some of the nuances of their perspectives, supports recommendations that may reduce the perceived acrimony surrounding discussions of NP independent practice in primary care.
初级保健提供者的短缺以及《平价医疗法案》（ACA）的条款引发了关于扩大初级保健执业护士（NP）数量、执业范围（SOP）和独立性的讨论。媒体和专业组织中的此类讨论可能暗示，对NP执业相关法律的修改将引发执业医生与NP之间的激烈争吵。然而，我们缺乏关于执业专业人员如何看待初级保健中NP独立性的实证性描述数据。
本研究的目的是探索和描述从事初级保健工作的医生和NP对NP独立性的态度。
一项基于扎根理论原则的定性研究。
美国密苏里州的30名初级保健专业人员，包括15名初级保健医生和15名初级保健NP。
半结构化深度访谈，数据分析以扎根理论为指导。
参与者的观点在专业组织或媒体中未得到充分体现。医生支持多种NP角色，对NP的高度独立性和自主性感到满意。医生和NP描述了NP独立性的互补性先决条件。医生普遍认为，为了患者安全，NP需要与医生有一定联系，而NP则更喜欢在需要时能随时找到医生。“知道自己的局限”这一主题对于NP和医生在NP独立性方面都很重要，且此前文献中未对此进行过描述。
NP和医生对初级保健中NP执业的看法并不像其代表性专业组织和新闻媒体所暗示的那样存在分歧。NP和医生之间的重大共识以及他们观点中的一些细微差别，支持了可能减少围绕初级保健中NP独立执业讨论所感知到的激烈争吵的建议。
