Health Services Research Centre, Victoria University of Wellington , Wellington, New Zealand.
Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington , Wellington, New Zealand.
J Health Organ Manag. 2019 Mar 18;33(1):63-77. doi: 10.1108/JHOM-02-2018-0064. Epub 2018 Oct 30.
The purpose of this paper is to lay out how advanced practitioner development occurs in New Zealand primary health care settings. The paper specifically focuses on mechanisms occurring across policy creation and in practice leading to successful role development.
DESIGN/METHODOLOGY/APPROACH: The authors applied a realist approach involving interviews, document review and field log observations to create refined theories explaining how successful development occurs.
Three final mechanisms were found to influence successful advanced practitioner role development: engagement in planning and integrating roles; establishing opportunities as part of a well-defined career pathway; and championing role uptake and work to full scopes of practice.
RESEARCH LIMITATIONS/IMPLICATIONS: This research focuses on one snapshot in time only; it illustrates the importance of actively managing health workforce change. Future investigations should involve the continued and systematic evaluation of advanced practitioner development.
The successful development of advanced practitioner roles in a complex system necessitates recognising how to trigger mechanisms occurring at times well beyond their introduction.
Potential candidates for new roles should expect roadblocks in their development journey. Successfully situating these roles into practice through having a sustainable and stable workforce supply provides patients with access to a wider range of services.
ORIGINALITY/VALUE: This is the first time a realist evaluation has been undertaken, in New Zealand, of similar programmes operating across multiple sites. The paper brings insights into the process of developing new health programmes within an already established system.
本文旨在阐述新西兰初级医疗保健环境中高级执业者发展的情况。本文特别关注政策制定和实践中成功角色发展的机制。
设计/方法/途径：作者采用了一种现实主义的方法，包括访谈、文件审查和现场日志观察，以创建解释成功发展的精炼理论。
发现有三个最终机制会影响高级执业者角色的成功发展：参与规划和整合角色；在明确的职业道路中建立机会；支持角色的采用和充分发挥实践范围。
研究局限性/影响：这项研究仅关注一个时间点；它说明了积极管理卫生人力变革的重要性。未来的研究应包括对高级执业者发展的持续和系统评估。
在复杂的系统中成功发展高级执业者的角色，需要认识到如何触发在其引入之前很久就发生的机制。
新角色的潜在候选人在其发展过程中可能会遇到障碍。通过提供可持续和稳定的劳动力供应，成功地将这些角色融入实践，为患者提供了更广泛的服务。
原创性/价值：这是新西兰首次对在多个地点运行的类似计划进行的现实主义评估。本文为在已建立的系统内开发新的卫生计划的过程提供了深入的见解。
