Interprofessional collaboration in a Primary Care Team: how autonomous are nurse practitioners?

Introduction: To provide high-performance integrated care, each professional must be able to practice to the full extent of his or her scope of practice (Pillar #5). However, in interprofessional primary care settings, some nurses experience practice limitations. Nurse Practitioners (NPs) can diagnose and prescribe in the province of Quebec, Canada. To improve accessibility of primary care services, avoid unnecessary referrals and better meet the needs of the population, they need to work to their full scope of practice and be supported in their role. A primary care clinic gave extensive power in terms of governance of their practice to a group of NPs. In this context, we wanted to study the level of autonomy of NPs. Aims, Objectives, and Methods: The aim of this study is to examine the autonomy of a group of NPs in a primary care clinic over their first 18 months. For each consultation, NPs indicated whether they had completed the consultation without assistance, whether they had consulted a doctor informally, or whether they had to refer the patient. Percentages have been calculated over 3-month periods. Results: Over an 18-month period, we collected information on 7141 consultations provided by 6 NPs. Overall, over the entire data collection period, NPs carried out 90.3% of their consultations autonomously (ranging from 81.7% to 95.1%), consulted a MD informally in 4.2% and refered the patient for 5.5% of cases. However, the proportion of autonomous consultations increases over time, rising from 69.8% in period 1 to around 95% in periods 4 to 7. Learnings: Our results demonstrate that NPs can autonomously manage the vast majority of primary care consultations. They also show that NPs need a period of 6 to 9 months to reach their maximum autonomy. This should be taken into account when implementing a new NPs position in terms of support and expectations. Next steps: Our results have two important implications for the development of sustainable integrated primary care. First, in interprofessional contexts where their full scope of practice is made possible we can rely on NPs to give accessible and comprehensive care to patients. Second, primary care managers should expect to provide practice development support and medical advices for the first 6-9 months, but this support will then be minimal.