MacNeill Lillian, Légère Karine, Balcom Sarah, Luke Alison, Justason Eve, Doucet Shelley
Department of Nursing and Health Sciences, University of New Brunswick, Saint John, Canada.
École de science infirmière, Université de Moncton, Moncton, Canada.
Can J Nurs Res. 2025 Sep;57(3):364-374. doi: 10.1177/08445621251333678. Epub 2025 Apr 16.
BackgroundAccess to primary care is a challenge across Canada. In the province of New Brunswick (NB), approximately 15% of citizens do not have a primary care provider (PCP). The Government of NB recently implemented clinics staffed by nurse practitioners (NPs) in various regions in the province to reduce the provincial waitlist for a PCP.PurposeThis study aimed to identify facilitators and barriers to NP-led clinic implementation, as perceived by clinic staff.MethodsUsing a cross-sectional qualitative descriptive design, data was collected using semi-structured interviews and analysed using qualitative content analysis.ResultsStudy participants included 16 employes of two NP-led clinics in NB (NPs, registered nurses (RN), licensed practical nurses (LPN), administrative staff, and managerial staff). Facilitators include having experienced mentors, collaborative practices, and well-equipped clinics. Barriers include rushed timelines, complex decision-making processes, large and complex caseloads, inadequate clinic space, and difficulty in staff recruitment and retention. Participants discussed the positive impact of NP-led clinics through improved access to primary care, resulting in reduced burdens on emergency departments and walk-in clinics. Participants recommend adding additional NP-led clinics and integrating multidisciplinary allied health professional teams to enhance care integration.ConclusionNP-led clinics are increasingly being implemented across Canada to improve primary care access, particularly in areas where there are shortages of PCPs. Findings from this study will help inform the development and implementation of other NP-led clinics across NB and Canada.
背景
在加拿大,获得初级医疗服务是一项挑战。在新不伦瑞克省(NB),约15%的居民没有初级医疗服务提供者(PCP)。NB省政府最近在该省不同地区设立了由执业护士(NP)配备人员的诊所,以减少全省PCP的等候名单。
目的
本研究旨在确定诊所工作人员所认为的NP主导诊所实施的促进因素和障碍。
方法
采用横断面定性描述设计,通过半结构化访谈收集数据,并使用定性内容分析法进行分析。
结果
研究参与者包括NB省两家NP主导诊所的16名员工(NP、注册护士(RN)、执业护士(LPN)、行政人员和管理人员)。促进因素包括有经验丰富的导师、协作实践和设备齐全的诊所。障碍包括时间紧迫、决策过程复杂繁重、工作量大且复杂、诊所空间不足以及员工招聘和留用困难。参与者讨论了NP主导诊所通过改善初级医疗服务可及性带来的积极影响,这导致了急诊科和随诊诊所的负担减轻。参与者建议增加更多NP主导的诊所,并整合多学科联合健康专业团队以加强医疗服务整合。
结论
加拿大各地越来越多地设立NP主导的诊所,以改善初级医疗服务可及性,特别是在PCP短缺的地区。本研究结果将有助于为NB省和加拿大其他NP主导诊所的发展和实施提供参考。