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AimTo evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs). BACKGROUND: People are living longer, most with one or more chronic diseases (mulitmorbidity) and primary healthcare for these patients has become increasingly complex. One response was the establishment of new models of primary healthcare. NPLCs are an example of a model developed in Ontario, Canada, which feature nurse practitioners as the primary care providers practicing within an interprofessional team. Evaluation of the extent to which the processes within NPLC model addressed the needs of patients with multimorbidity is warranted. METHODS: Eight nurse practitioners were interviewed to determine their perception of the quality of care provided to patients with multimorbidity at NPLCs. Interpretive description guided the analysis and themes were identified.FindingsThree themes arose from the analysis, each of which has an impact on the quality of care. The level of patient vulnerability at the NPLCs was high resulting in the need to address social and financial issues before the care of chronic conditions. Dynamics within the interprofessional team impacted the quality of patient care, including NP recruitment and retention, leaves of absence and turnover in staff at the NPLCs had an effect on interprofessional team functioning and patient care. Finally, coordination of care at the NPLCs, such as length of appointments, determined the extent to which attention was given to individual clinical issues was a factor. Strategies to address social determinants of health and for recruitment and retention of NPs is essential for improved quality of care. Comprehensive orientation to the interprofessional team as well as flexibility in care processes may also have positive effects on the quality of care of patients with complex clinical issues.

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

This article describes the development of nurse practitioner (NP) competencies for advance care planning. Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge, and level of implementation of advance care planning. In round 2, 29 NPs participated in the evaluation of the draft competencies and their components. Revisions were made, and a final round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes 4 competencies, each with several elements: (1) Clinical Practice, (2) Consultation and Communication, (3) Advocacy, and (4) Therapeutic Management. Advance care planning competencies will provide NPs with a guide that can be used to ensure that they are able to clearly identify their distinct role in advance care planning. These competencies may inform the integration of advance care planning in a variety of health care settings and with other health care providers.

Background Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model. Purpose Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics. The aim of this study was to evaluate the extent to which diabetes care was complete and to determine the impact of organizational tools, including electronic medical record tracking, diabetes care template, and referral to community programs, on the completeness of care for patients with diabetes and multimorbidity at Nurse Practitioner-Led Clinics. Methods An audit of 30 charts was conducted at five different Nurse Practitioner-Led Clinics (n = 150) for patients with diabetes and at least one other chronic condition. Indicators included patient and organizational characteristics as well as diabetes care items taken from diabetes clinical guidelines. Results Overall, care for patients with diabetes and multimorbidity in Nurse Practitioner-Led Clinics was complete. However, there were no significant associations between patient or organizational characteristics and the extent to which diabetes care was complete.

It is estimated that the number of people who die of life-limiting illnesses in Canada will double by the year 2056. Advance care planning (ACP) is one way to improve the quality of end-of-life care. ACP is a process of ongoing discussions whereby a person communicates important values and desired outcomes at the end of life prior to healthcare crises. Nurse practitioners (NP) commonly diagnose and plan healthcare for patients who may have life-limiting conditions and thus are in a strategic position to engage patients in ACP. Currently, we have a poor understanding of the extent and nature of NP involvement in ACP. This descriptive study explored Ontario NPs' knowledge, beliefs and level of implementation of ACP. NPs employed in hospital settings were significantly more likely to engage in ACP with patients and to have a policy governing ACP initiation compared with their community-employed counterparts. There were no significant differences between the NPs in these two settings in the beliefs, attitudes or personal comfort in initiating ACP. Implications for education, practice and research are provided.

The previous 16 years have seen a number of healthcare reforms meant to increase access to primary healthcare services in Ontario. This included the establishment of an innovative model, the nurse practitioner-led clinics (NPLCs). NPLCs held promise for nurse practitioners (NPs) to practice to their full potential and optimize patient care. A multiple-case study was undertaken to evaluate the quality of care for patients with diabetes and multimorbidity at NPLCs. Five NPLCs, all in underserved areas in the mid-northern region of the province, were part of the study. Data collection included a chart audit, NP interviews and review of organizational information. Multiple-case analysis was conducted and four interrelated themes emerged about the quality of care of patients with diabetes and multimorbidity at the NPLCs. It was confirmed that the NP is the primary care provider at NPLCs. Healthcare policy such as a lack of increase in NP salary for 10 years has contributed to poor NP recruitment and retention. Insufficient healthcare resources in the communities where NPLCs are located and high patient vulnerability have a negative influence on the quality of care. Strategies, including mentoring, offer possible solutions to improve the quality of care at NPLCs.

Aims: To determine the perceptions of nurse practitioners (NPs) about the level of functioning of their interprofessional teams., Background: Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning., Methods: Ninety-eight NPs at a conference completed the Interprofessional Team Functioning Survey (ITFS)., Results: The survey items with the lowest mean scores were related to organisational systems. These items included workplace policies that support interprofessional teamwork, in particular, orientation to the interprofessional team. Items that generated lower mean scores were adequate time to work as a member of the interprofessional team, team dynamics, collaboration among team members and the sharing of responsibility., Conclusion: Organisational and team relational issues can be addressed through organisational management strategies. Nurse managers have an important role in facilitating high functioning interprofessional teams., Implications for Nursing Management: Strategies for managers to support interprofessional team functioning emerged. These strategies include ensuring that there are appropriate policies, orientation of new members, allocation of time to support interprofessional teamwork, leadership to enhance team collaboration and clear delineation of responsibilities of each member., (© 2013 John Wiley & Sons Ltd.)

Purpose: Nurse practitioners (NPs) in Ontario, Canada, experience many barriers to practice that negatively influence their ability to increase access to comprehensive primary healthcare services. A NP-Led Clinic Model has helped to overcome many of the barriers and has had a real impact on access to care., Data Sources: Legislative and regulatory documents from the government of Ontario were reviewed. Reflection upon the barriers to NP practice in Ontario and the positive impact of the new model of care is presented., Conclusions: NPs with a voice in the governance and operations of a workplace have the potential to reduce barriers to practice., Implications for Practice: Lessons for NPs internationally can be learned from the experience of the Ontario NP-Led Clinic Model., (©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.)

A unique and innovative model of primary healthcare (PHC) delivery began at the Sudbury District Nurse Practitioner Clinics (SDNPC) in 2007. Significant growth and development has taken place since the opening of this new model of PHC delivery. Now that SDNPC is operating at full capacity, an evaluation was warranted of patient experiences with clinic services and the level of overall patient satisfaction. A survey of clinic patients was conducted in the spring of 2011. Results demonstrated high satisfaction with clinic services. Some areas were identified for review, including the level of accessibility to same-day appointments and rationale for patient use of walk-in clinics and emergency department care. One of the strengths and benefits of this model of NP care was demonstrated in this evaluation, whereby a majority of patients identified that they had received counselling about a lifestyle issue and, of those patients, most reported a resulting positive health-related behavioural change. Ongoing comprehensive evaluation is important to ensure that services are efficient and directed to optimal patient health outcomes.

Canada's first nurse practitioner-led clinic opened in 2007 after a period of intense lobbying. The development of this clinic has received a great deal of attention in the nursing world and among the general public, but the factors that enabled it have not been examined. The antecedents outlined in healthcare innovation concept analysis - including leadership, financial considerations, idea generation, teamwork, culture and demand - provide a framework for examination of the campaign for the nurse practitioner-led clinic. This review demonstrates the complex interplay of factors that drive healthcare innovation and expands understanding of the leadership and change competencies of the advanced practice nurse.

Background There is no common understanding about the role of the advanced practice nurse across the globe and there is wide variation in the regulation of advanced practice nursing roles as well as their educational, licensing and credentialing requirements. Aim The goal of this research was to examine the status of advanced practice nursing regulation globally. Methods An online survey link was emailed to National Nursing Associations and nursing health policy makers worldwide from June to December 2011. Questions focused on regulation, education, scope of practice, and barriers and opposition. Analysis included frequency statistics and descriptive data for survey questions and content analysis for two open-ended questions. Limitations The survey was offered online and only in English. Therefore, technology and language barriers may have influenced the results. Results There is wide variation in educational requirements, regulation and scope of practice of advanced practice nurses. The barriers to advanced practice nursing are often linked to the status of legislation and credentialing in specific jurisdictions. Conclusion A database of advanced practice nursing regulation and issues related to practice has the potential to become a valuable resource for individual countries. Implications for nursing and health policy Each country has unique challenges related to health policy for advanced practice nursing roles. International nursing organizations have established programmes for regulation development; however, a stronger focus on monitoring regulation and more effective dissemination of information about available supports may have a bigger impact on the development and revision of health policy related to advanced practice nursing. [ABSTRACT FROM AUTHOR]