A CASE STUDY OF THE PROCESS OF NURSE PRACTITIONER ROLE IMPLEMENTATION WITHIN A HEALTH AUTHORITY IN BRITISH COLUMBIA
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At the time of this study (2009) the role of the nurse practitioner (NP) was new to the province of British Columbia (BC). The provincial government gave the responsibility for implementing the role to health authorities. Managers of health authorities, many of whom were unfamiliar with the role, were responsible for identifying the need for the NP role, determining how the NP would function, and gaining team members’ acceptance for the new role. The purpose of the study was to explain the process of NP role implementation as it was occurring and to identify factors that could enhance the implementation process. An explanatory, single case study with embedded units of analysis was used. Three primary health care (PHC) settings in one health authority in BC were purposively selected. Data sources included semi-structured interviews with participants (n=16) and key documents. Propositions and a conceptual framework developed from the review of the literature guided the study. Key components of the framework were the concepts of intention, involvement and acceptance. The results demonstrate the complexity of implementing the NP role in settings unfamiliar with it. The findings suggest that early in the implementation process and after the NP was hired, team members needed to clarify intentions for the role and they looked to senior health authority managers for assistance. Acceptance of the NP was facilitated by team members’ prior knowledge of either the role or the individual NP. Community health care providers needed to be involved in the implementation process and their acceptance developed as they gained knowledge and understanding of the role. Although relatively new in their roles, NPs were enacting, to some degree, all competencies of the role, as defined by College of Registered Nurses of BC. The findings suggest that the interconnectedness of the concepts of intention, involvement and acceptance influences the implementation process and how the NP is able to function in the setting. Without any one of the three concepts not only is implementation difficult, but it is also challenging for the NP to fulfill role expectations. Implications for research, policy, practice and education are discussed.