Enhancing Nurse Practitioner Image, Role Development, and Autonomy through Collaboration

1. Enhancing Nurse Practitioner Image, Role Development, and Autonomy through Collaboration Kristen Kessinger University of Central Florida NGR 6273

2. Scope: History and Background of the Issue • Nurse practitioners can provide needed support for our changing healthcare system and increased medical needs of our country. • Several barriers stand in the way of allowing NPs to practice to the full extent of their training and education. • With fast changes in our complex health care system, quality care is critical in providing cost effective care that meets the needs of our aging country. • NPs face role confusion from both their personal experience and in working with other health care professionals. • Lack of familiarity with role, lack of respect, and inconsistent attitudes towards NP practice can prevent NPs from practicing to their full extent (Burgess& Purkis, 2010).

3. Scope: History and Background of the Issue • Poor collaboration between NPs and other healthcare team members can greatly impact: • quality of care • professional role development and satisfaction • the image of the nurse practitioner profession. • Poor collaboration can lead to serious issues in regards to safety, continuity of care, and communication with patients and families (Faith Donald, 2009).

4. Scope: History and Background of the Issue Barriers to collaboration (Clarin, 2007) - Lack of knowledge about NP role and scope of practice - Poor physician attitude - Lack of respect - Poor communication  - Patient and family reluctance of NP role

5. Identification of the Problem Nurse practitioners need to make changes to practice in effort to: - enhance their image in the healthcare community - improve role clarity within the healthcare team -practice to the full extent of their scope in order to provide quality care in our complex healthcare system.

6. Role of the nurse leader • With increased use of NPs in the medical field, NPs need to step up and also take a leadership role within the healthcare team. • Giving NPs a voice they can feel empowered to: -change healthcare policy - impact their professional image -work towards increased autonomy. Enhancing autonomy and collaboration among health care professionals can help to advance NP role integration (Burgess & Purkess, 2010).

7. Alternative Solutions • Increase NP autonomy and enhance role image through legislative efforts to remove practice and supervisory restrictions on NPs. • Autonomous practice can help meet changing health care needs and enhance professional identity (Pruitt et al., 2002). • Media campaigns help generate publicity and improve visibility for the advanced nursing role (Newland, 2007). • NP residency programs and mentors help ease transition and generate role clarity for new practitioners (Goudreau et al., 2011; Hollinger-Smith & Murphy, 1998)

8. Solution and Rationale • Enhancing collaboration between NPs, physicians, and other disciplines is a great strategy to increase quality of care and promote NP image and autonomy. • This notion of collaboration needs to be differentiated from "supervision" of NPs by MDs. • Collaboration involves high degrees of assertiveness and cooperativeness (Maylone et al., 2009). All team members are valued for their unique contributions to the decision making process (Burgess & Purkis, 2010).

9. Solution and Rationale • Burgess and Purkis (2010) found that collaboration was foundational to everyday practice and aided the advancement and integration of NP roles. • Helped NPs to explore new practice approaches, enhance professional partnerships, and foster their autonomy. • Aided in bridging the professions of nursing and medicine, allowing NPs to realize their distinct role and establish professional identity and role clarity. • Increased capacity to provide quality care and try innovative interventions.  It can also help to engage jointly in political action that can help improve healthcare

10. Solution and Rationale Maylone et al. (2009) finds that collaboration between NPs and physicians improves the quality and cost of healthcare and also enhances professional satisfaction. Physicians who work with NPs agree that NPs help attract new patients and can provide most primary care. Patients are willing to receive care from NPs and help to free up physicians time and add a positive dimension to the office (Street & Cossman, 2009). In the long term care setting, NP and physician collaboration and lead to a more efficient use of physician time. Collaborative teams have shown a reduction in hospitalizations and cost savings, an increase in resident knowledge, access to care, and better relationships between nurses and physicians (Faith Donald et al., 2009).

11. Solution and Rationale Benefits of Collaboration (Clarin, 2007): - Decreased length of stay - Improved medical management and health maintenance with decrease in unnecessary office visits - Better comprehensive patient education - Greater patient satisfaction

12. Implementation Plan • To help the NP profession move forward and actualize a better healthcare system, collaborative efforts are required by nurses, MDs, policymakers, and the public. • Continual education of colleagues on the importance of collaboration is critical (Burgess & Purkis, 2010). • Many MDs often feel they are legally liable for the care NPs provide. • Providing autonomous NP practice can help alleviate this barrier (Schadewaldt et al., 2013).

13. Implementation Plan • Factors that can help foster collaboration include: -working in close proximity with partners -taking time for regular meetings -having a positive attitude towards collaboration -official recognition of NP role, including legal protection. Better information strategies about the NP role and an earlier exposure to inter-professional education can also help (Schadewaldt et al., 2013). • A written collaborative contract can allow for open discussion and outline duties/roles so that role overlap does not occur. Use of clinical practice guidelines can also help to clarify roles (Faith Donald et al., 2009).

14. Implementation Plan In the long term care setting Faith Donald et al. (2009) found that NPs were rarely included in rounds and quarterly reviews of patient progress. Allowing NPs to be a part of this can greatly enhance collaborative efforts. Most important, for those professionals who have achieved successful relationship, they should serve as mentors for future physician, NP dyads and help them towards attaining a successful collaboration (Faith Donald et al., 2009).

15. Implementation Plan Strategies to help improve from Clarin (2007): - Provide formal orientation regarding NP/physician collaboration -Expose medical students early on to advanced practice nursing role - Strive for uniform NP education, certification, and scope of practice - Use of integrated collaboration models - Interdisciplinary rounds with NP involvement - Monthly team meetings that discuss collaboration and hold team members accountable for their part.

16. Plan for Evaluation • Faith Donald et al. (2009) propose annual evaluations of NP and physicians. • This allows the dyad to discuss what is going well and areas of improvement. • A strategic plan can then be devised to strengthen the relationship. • In regards to collaboration in a long term care setting, the idea of a "teaching nursing home" that attracts medical students can help facilitate collaboration between NPs and MDs (Faith Donald et al., 2009).

17. Plan for Evaluation To evaluate the importance of collaboration further research can look into exploring the effect of the collaborative relationship on patient care outcomes. Perhaps, studies can be done assessing patient satisfaction to determine effectiveness of NP/physician collaboration (Clarin, 2007).

18. References • Bailey P, Jones L, Way D. (2006). Family physician/nurse practitioner: stories of collaboration. Journal Of Advanced Nursing. February 15, 2006;53(4):381-391. • Burgess, J., & Purkis, M. (2010). The power and politics of collaboration in nurse practitioner role development. Nursing Inquiry, 17(4), 297-308. doi:10.1111/j.1440-1800.2010.00505.x • Clarin, O. A. (2007). Strategies to overcome barriers to effective nurse practitioner and physician collaboration. Journal for Nurse Practitioners. 3(8):538-548.  • Donald, F., Mohide, E., DiCenso, A., Brazil, K., Stephenson, M., & Akhtar-Danesh, N. (2009). Nurse practitioner and physician collaboration in long-term care homes: survey results. Canadian Journal On Aging, 28(1), 77-87. doi:10.1017/S0714980809090060 • Goudreau, K. A., Ortman, M., Moore, J. D., Aldredge, L., Helland, M. K., Fernandes, L. A., & Gibson, S. (2011). A Nurse Practitioner Residency Pilot Program. Journal Of Nursing Administration, 41(9), 382-387. doi:10.1097/NNA.0b013e31822a7315 • Hallas, D., Butz, A., & Gitterman, B. (2004). Attitudes and beliefs for effective pediatric nurse practitioner and physician collaboration. Journal Of Pediatric Healthcare, 18(2), 77-86. • Hollinger-Smith, L., & Murphy, M. (1998). Advanced practice. Implementing a residency program for the acute care nurse practitioner. MEDSURG Nursing, 7(1), 28.

19. References • Maylone, M., Ranieri, L., Quinn Griffin, M. T., McNulty, R., & Fitzpatrick, J. J. (2011). Collaboration and autonomy: Perceptions among nurse practitioners. Journal Of The American Academy Of Nurse Practitioners, 23(1), 51-57. doi:10.1111/j.1745-7599.2010.00576. • Newland, J. (2007). Tinseltown Nurses and Public Perception. Nurse Practitioner. p. 5. • Pruitt, R. H., Wetsel, M., Smith, K. J., & Spitler, H. (2002). How do we pass NP autonomy legislation?. Nurse Practitioner, 27(3), 56. • Putnam, J., Ikeler, S., Raup, G., & Cantu, K. (2014). There's no "I" in team: evaluating nurse-physician collaboration. Nursing Management, 45(1), 10-13. doi:10.1097/01.NUMA.0000440636.71636.ea • Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2013). Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care -- an integrative review. BMC Family Practice, 14(1), 132-142. doi:10.1186/1471-2296-14-132 • Street, D., & Cossman, J. S. (2010). Does familiarity breed respect? Physician attitudes toward nurse practitioners in a medically underserved state. Journal Of The American Academy Of Nurse Practitioners, 22(8), 431-439. doi:10.1111/j.1745-7599.2010.00531