Senior and Advanced Practitioners as part of the multidisciplinary team The Reality of Practice Ms J Corcoran- Lead practitioner for professional

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Senior and Advanced Practitioners as part of
the multidisciplinary team The Reality of
PracticeMs J Corcoran- Lead practitioner for
professional Role Development
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Aims of Session

• To present the findings of a qualitative study.
• To provide a theoretical understanding on current
  barriers
• To highlight strategies to facilitate such roles
  within a team context.

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Design Method

• Charmaz (2006) constructive Grounded Theory (GT)
  approach was employed
• Data collection was via in depth interviews from
  18 mulitprofessionals who had worked with an SNP
  or ANP within an acute care setting in Scotland.
• Data were analysed by constant comparative
  analysis inherent with this GT approach.

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Background

• In the United Kingdom government policy has
  highlighted the need for NHS modernisation
  central to this reform is multidisciplinary team
  working (DOH 2000SGHD 2007).
• These changes have also lead to an increase in
  SNP/ANP roles.

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Research Question

• How do members of the multiprofessional team
  perceive the senior or advanced practitioner
  role?
• This research was part of phase one of a larger
  Grounded Theory study.
• The purpose of the first phase was to develop a
  theoretical understanding of a wide range of
  stakeholders to inform phase two of the overall
  study.

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Design Method

• In-depth interviews following a topic guide was
  employed for data collection.
• Data collection took place in 2007, exclusion
  criteria for this study was participants who did
  not have an experience working with a senior or
  advanced practitioner.

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Sample

• The sampling strategy was inherent within the
  constant comparative method, data were analysed
  and a number of themes emerged that informed the
  sampling strategy.
• 18 multidisciplinary team members participated in
  the study

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Results

• Professional Cultures
• Doctor/Nurse practitioner game
• Nurse/Nurse practitioner game

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Professional Cultures

• It has been widely reported that the underlying
  philosophical base of professions within a health
  care team may limit true multiprofessional
  working.
• (Firth -Cozens 1998 Finch 2000 Zwarenstein
  Reeves 2000 Kavanagh Cowan 2004).

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Professional Cultures

• Kavanagh Cowan (2004) propose that teams within
  the NHS can be deeply hierarchical with big
  differences in status and rewards between team
  members.

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Professional Cultures

• Thomas (nurse) illuminates one of issues in
  relation to communication and professional
  cultures when he states
• I mean its all very hierarchical, and I think
  we are very aware of that because we are lower
  down in the hierarchy than them and that
  naturally breeds a resentment, you know, Oh
  why should I clean up after them, they earn more
  than me!

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Professional Cultures

• All participants outlined that a barrier to these
  roles was due to differences in professional
  cultures.
• In words of George (Medic)
• We are from different professional cultures
  maybe thats why it doesnt work.
• Whilst Mickey (Medic) further elaborates,
• I think for the junior doctors thats much more
  difficult, there is still kind of Im a doctor
  youre a nurse, youre below me.

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Professional Cultures

• All participants within this study highlighted
  that resistance to NP roles came from both
  medical and nursing professions, In the words of
  Fraser (Consultant Medic)

Its like some sort of doctor and nurse game and
then youve got the nurse and nurse practitioner
game.
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Doctor/Nurse practitioner game

• All medics (n8) highlighted that there is a lot
  of resistance towards NPs as they are
  undertaking roles that they would never have been
  allowed to do previously.

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Doctor/Nurse practitioner game

• Michael a junior surgeon outlined that there is
  still resistance to these roles, when he stated
• There comes a point where, sort of, a boundary
  may well have to be drawn where if somebody would
  say you know essentially this is the kind of
  thing that medical school might prepare you for,
  and not nursing school.

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Doctor/Nurse practitioner game

• Jayne (Junior Charge Nurse),
• Some of the medical staff focus on the negative
  component. Whether that be that theyre
  threatened because of their roles changing or a
  general blurring of roles in departments.

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Nurse/Nurse practitioner game

• All nursing and medical participants (n16)
  illuminated the perception that nurse
  practitioners are treated with hostility from
  other nurses.

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Nurse/Nurse practitioner game

• Mark (Medic) illustrates medical participants
  views,
• The bigger issue that there is nurses not medics
  and Ive had this where nurses have phoned up
  and said I need to speak to the doctor and
  refused to speak to the nurse practitioners.
  but those are the people who make some nurse
  practitioners lives miserable you think youre
  something special now

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Nurse/Nurse practitioner game

• Nurse practitioners originate from the same
  profession as nurses therefore one could debate
  if the resistance is generated from a NP making
  decisions rather than a medic.
• In the words of George (Medic)
• The nurses say whos this jumped up so and so
  coming and telling me how to do my job

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Nurse/Nurse practitioner game

• One could liken this to the doctor-nurse game,
  this links to the original work of Berne (1964).
• In a social system individuals play games in all
  human relationships.
• Roles also become personal for individuals and
  these personal expectations shape or define the
  role of a nurse.
• Debate that NPs who are seen to be in
  substitution roles, are viewed as an alternative
  doctor rather than a nurse within this social
  game.

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Nurse/Nurse practitioner game

• Louise (Nurse) illustrates,
• Nurses are hard on nursesOther staff will do
  things for a doctor but wont help if its a
  nurse practitionersomething in the hierarchy of
  nursing.

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Nurse/Nurse practitioner game

• As Thomas (Nurse) states,
• These roles were forced upon us.
• Whilst Rosie (Medic) illustrates,
• You know the nurses in the ward dont seem to
  accept them, its like theyre deserting their
  kind, you know and going off to the dark side as
  such

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Current Barriers

• It would appear that traditional professional
  boundaries within a multiprofessional team
  context are hindering the acceptance of NP roles
  within practice.
• Hybrid role increase level of resistance

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Current Barriers

• This has implications on the acceptance of such
  roles and thus the ongoing socialisation of
  working within multiprofessional teams.
• Resistance is apparent from both nursing and
  medicine perspectives, fuelled by the lack of
  clarity surrounding varying NP roles within the
  research site.

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Current Barriers

• Junior medical staff resistance appears to stem
  from a professional belief system, encompassing
  the perceived reduction in training opportunities
  due to the implementation of such roles

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Current Barriers

• NP roles raise identity issues for most nurses,
  with the undercurrent that such individuals
  within these roles are deserting their profession
  and siding with medicine.
• This appears to be threatening for nurses as it
  challenges their professional belief system
  surrounding what it is to be a nurse.

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Strategies to facilitate such roles within a team
context.

• Service led NHS Not professional rigid NHS
  service.
• Clear outline of how such roles will work within
  a team.
• Organisational planning with different members of
  teams input in planning.
• Dual reporting structure .

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Any Questions