Clinical and Organizational Nursing Innovations in Primary Care: Findings From a Stakeholders' Symposium.

Nursing innovations in primary care, based on interprofessional care models, could be better identified, recognized, and deployed. This article presents the results of a symposium discussing the implementation of nursing innovations in primary care in Quebec, Canada, in partnership with researchers and stakeholders. Built on the appreciative inquiry approach, 9 nursing innovations were described. To support the implementation of such nursing innovations responding to current primary care issues and population needs, 4 recommendations emerged: the need to implement strategies to achieve optimal scope of practice for primary care nurses; the importance to develop funding and organizational models that support primary care nursing innovation; the need to enhance a collaborative and democratic governance open to innovation; and the opportunity to create partnerships with the research community and teaching institutions.

Enacting primary healthcare interprofessional collaboration: a multisite ethnography of nurse practitioner integration in Ontario, Canada.

Interprofessional collaboration (IPC) is known to enhance patient outcomes and satisfaction. In primary healthcare (PHC), IPC aims to transform care provision and team functioning, but its implementation is challenging and has yielded mixed results. We aimed to describe the enactment of IPC in PHC settings, particularly as it relates to nurse practitioner (NP) integration. A multisite ethnography involving 6 Canadian PHC clinics was carried out. We conducted 330 hours of direct observation, 23 semi-structured interviews with PHC NPs, informal interviews with key PHC partners, and document analysis. IPC in PHC was found to rest on human and non-human actors that interact in complex ways. Organizational mandates and remuneration models, physical spaces and schedules played a decisive role in the enactment of IPC. Power structures embedded in certain designations (i.e., most responsible provider) or NPs' commitments to physicians' practices stood in contrast with the principles of IPC. NPs enacted various role to develop, enhance, and maintain IPC. Despite shifts in PHC provision, IPC remains poorly defined and precariously sustained.

[The integration of nurse practitioners into primary health care: Rethinking the negotiation of complex dynamics]. / Intégration des infirmières praticiennes en soins de santé primaires : repenser la négociation de dynamiques complexes.

Background : The integration of nurse practitioners into primary healthcare settings is highly complex, yet it has not been extensively studied with regard to broader socioprofessional changes occurring in health care.Objective : This study sought to examine the integration and negotiation of the role of nurse practitioners in interprofessional primary healthcare settings.Method : A critical ethnography framed by actor-network theory and Foucault's concepts of discourse and power was conducted in three different primary healthcare models in which semi-structured interviews (n=23 nurse practitioners), direct observation, and document analysis were performed.Results : Organizational aims, practice standards, nurse practitioners' right to self-determination, collaborative dynamics with physicians, and patient management were identified as integration factors that produced greater instability, needs for negotiation, and professional, identity, and moral difficulties for nurse practitioners.Discussion : The findings from this study challenge the widespread perception that the role of nurse practitioners lacks clarity and enable a renewed understanding of their integration process in primary healthcare settings.

Intégration des infirmières praticiennes en soins de santé primaires : repenser la négociation de dynamiques complexes.

Background : The integration of nurse practitioners into primary healthcare settings is highly complex, yet it has not been extensively studied with regard to broader socioprofessional changes occurring in health care.Objective : This study sought to examine the integration and negotiation of the role of nurse practitioners in interprofessional primary healthcare settings.Method : A critical ethnography framed by actor-network theory and Foucault's concepts of discourse and power was conducted in three different primary healthcare models in which semi-structured interviews (n=23 nurse practitioners), direct observation, and document analysis were performed.Results : Organizational aims, practice standards, nurse practitioners' right to self-determination, collaborative dynamics with physicians, and patient management were identified as integration factors that produced greater instability, needs for negotiation, and professional, identity, and moral difficulties for nurse practitioners.Discussion : The findings from this study challenge the widespread perception that the role of nurse practitioners lacks clarity and enable a renewed understanding of their integration process in primary healthcare settings.