Policy,Politics,& Nursing Practice

Violence and aggression toward nurses are global concerns. Despite repeated research on causal factors and widespread zero tolerance campaigns, rates of violence and aggression have not declined. Violence and aggression toward nurses can negatively affect their health and ultimately patient care. Media reporting of violence and aggression toward nurses might shape people’s perceptions of the profession, perhaps impeding nurse recruitment and retention efforts in the face of global nursing shortages. The purpose of this study was to determine how print media in Scotland depicted reports of violence and aggression toward nurses. We used qualitative thematic analysis of newspaper articles and online news reporting of incidents of violence and aggression toward nurses between June 1, 2006 and May 31, 2016. Searches of Nexis and British Broadcasting Corporation (BBC) News Online databases returned 92 relevant newspaper articles. Standards for reporting qualitative research informed presentation of results. Key themes included blame (of perpetrator or senior management), helplessness (of nurses specifically or victimization), culture (social or organizational), and prevention and reduction measures. We concluded that media coverage of violence and aggression was overwhelmingly negative and reductionist. Normalization of violence and aggression was an accepted and acceptable part of the nursing role. We conclude with recommendations for policy and call for nurse leaders to challenge this culture of acceptability, especially to support recruitment and retention of nursing staff.

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.

Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider comanagement of the same patient has emerged in practice. Provider comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician–physician comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)–physician comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP–physician comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP–physician comanagement. Physicians and NPs are optimistic about comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP–physician comanagement should be supported in clinical practice.

The state of Georgia faces challenges in providing access to care, largely due to rural hospital closures and physician shortages. Although nurse practitioners (NPs) could help address Georgia's urgent health care needs, the state remains restrictive with respect to NP scope of practice (SOP). This study examined factors that influence Georgia legislators' decision-making on NP SOP. In June 2016, after the January through March legislative session, a questionnaire was e-mailed to 49 state legislators on the Committees on Health and Human Services in Georgia's House of Representatives and Senate. The questionnaire was adapted from a legislative questionnaire previously used in research on state educational policy. Nine of 49 (18%) Georgia legislators responded. The majority of nine respondents were Republicans having served less than 15 years in the legislature. The number of respondents was approximately equal between Senate and House of Representatives. The respondents rated expert testimony and hearing from constituents as most likely to influence their decision-making on NP SOP. They reported that media and concerns about reelection were least likely to influence their decision-making about NP SOP. Therefore, nurses who aim to influence state policy should consider legislator preferences, such as speaking personally with constituents and receiving expert testimony. In-person communication could enhance interactions with legislators, potentially improving policy outcomes. Future research is necessary and should be conducted by NPs to determine the forms of communication and content in testimony most effective in influencing state lawmakers about NP SOP and examine if results vary by state political or other contexts.