Faculty of Social Sciences, Université Laval, Quebec City, Canada.
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec City, Canada.
BMC Health Serv Res. 2019 Nov 21;19(1):882. doi: 10.1186/s12913-019-4731-8.
Optimising health professionals' contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada).
We used Giddens' structuration theory to guide our study given its' facilitation of the understanding of the dynamic between structural constraints and actors' actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017.
Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others' inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs' sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity).
Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.
优化卫生专业人员的贡献是有效和高效利用卫生人力资源的重要步骤。然而，尽管在实施高级实践护理角色方面做出了相当大的努力，包括在初级保健环境中（PHCNP），这些角色的优化仍然存在差异。在这项研究中，我们报告了一群在魁北克省（加拿大）的 PHCNP 的主观工作经验。
我们使用吉登斯的结构化理论来指导我们的研究，因为它促进了对结构约束和参与者行动之间的动态的理解。使用定性描述性研究设计，特别是个人和焦点小组访谈，我们在 2016-2017 年期间在魁北克的三个医疗保健区域进行了调查。
有 41 名 PHCNP 参与。他们对自己经验的描述分为两类。第一类是他们对他人对其角色的理解和重视不足的看法，包括某些工作条件的影响、对专业自主权的感知限制以及夹在两种专业模式之间的感觉。第二类是 PHCNP 对工作的投入感，包括与工作所处特定环境相关的观点，例如，角色的脆弱性取决于他们工作的特定诊所/或与他们一起工作的人。这种脆弱性还与魁北克实施的某些医疗改革有关，例如，要求医生提高生产力的立法。
出现了一些新的见解，例如 PHCNP 所经历的角色脆弱感。研究结果表明，工作环境、PHCNP 对工作的意义以及他们的投入之间存在着总体联系。在患者护理层面上优化其角色似乎受到组织和卫生系统环境层面因素的影响。似乎角色优化必须包括建立有利于实施和部署新专业角色、工作投入、在跨专业团队中进行有效协作以及行使代理权的工作环境和一致的卫生环境结构。需要进一步研究来评估努力实现这些目标的举措。
