What is the impact of advanced primary care nursing roles on patients, nurses and their colleagues? A literature review

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Abstract

Objectives

To review and draw together the existing research evidence to assess the impact of advanced primary care nursing roles, particularly first contact nursing roles, for patients, nurses themselves and their colleagues in order to highlight salient issues for policy, practice and research.

Background

Internationally, nurses’ roles continue to expand in response to doctor shortages and policy drives to provide effective and efficient health services. A body of research exists from which to evaluate the impact of advanced nursing roles on various dimensions of healthcare delivery and organisation.

Design and data sources

Medline, CINAHL, Applied Social Sciences Index and Abstracts, British Nursing Index, Cochrane Library, EMBASE, National Research Register, and PsycINFO databases were searched, including relevant websites. Studies were included if published in English and relevant to the primary/community care setting. Of a total of 211 papers identified, 88 were of relevance and included in the review.

Results

Nurses working in many advanced primary care roles such as acute/minor illness, minor injury and long-term conditions provide safe and effective care, and patient satisfaction is generally high. Many factors influence patient satisfaction with, and access to, such services but are little understood. Evidence on cost-effectiveness, efficiency and impact on other health care professionals is inconclusive though research suggests the introduction of extended roles can create uncertainty and intra-/inter-professional tensions.

Conclusions

Evidence is of variable quality, often ignoring potentially important effect mediators such as the experience and educational level of advanced nurses, the effect of service ‘maturation’, organisational characteristics and differing patient preferences. The complex range of factors that influence patient satisfaction, access and outcomes of care need further investigation. Recent UK developments in nurse prescribing and the introduction of a national post-registration competency framework may improve working relations and patient understanding and experience of advanced nursing roles in primary care.

Section snippets

What is already known about the topic?

  • The expansion of nursing roles in primary care appears set to continue as policy makers juggle cost containment and work force shortages along side the need to improve the quality of health services.

  • Nurses substituting for, or complementing, some areas of work traditionally undertaken by family physicians, including first contact care, provide care comparable to that of doctors and patient satisfaction is consistently high.

  • Some nurses working in advanced primary care nursing roles experience

What this paper adds

  • Evidence on the cost-effectiveness of advanced primary care nursing services is inconclusive and complex factors such as patient satisfaction, different dimensions of access, and workload require further exploration.

  • Potential effect mediators such as the organisational characteristics and practice culture, experience and educational level of advanced nurses and service ‘maturation’ are often ignored in the research evidence.

  • The introduction of a national UK post-registration competency

Aim and methods

The aim of the review was to identify and collate the research evidence from the international literature to provide an overview of the impact of nurse-led first contact care and other APCN services in primary care for a range of outcomes.

The search strategy included studies on the effectiveness of APCN services, including dimensions of accessibility and acceptability to patients, safety, costs, workload impact, recruitment, retention and related workforce issues. Electronic databases, websites

Results and discussion

Although the aim was to provide a comprehensive overview of the evidence, not a systematic review, we used established methods (Centre for Reviews and Dissemination, 2001) to ensure the process was systematic and transparent. Our search strategy was inclusive and we are confident that most relevant studies were located; however, we cannot claim to have identified all the research in the field. It was not our aim to provide an evidence synthesis given the broad scope of the review and the range

Conclusion

This review provides an overview of the impact of APCN roles in primary/community care for a range of outcomes. Given the broad nature of this research area, a ‘systematic review’ of the literature was not undertaken. However, failure to identify studies is unlikely as a systematic and transparent approach was used.

The expansion of nursing roles in primary care appears set to continue as policy makers juggle cost containment and work force shortages along side the need to improve the quality of

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