Lived Experience of Expert Acute Neurovascular Nurse Practitioners Working in Expanded Roles: A Mixed Methods Study

Introduction. Vascular neurology is overwhelmed by specialty physician shortages. We aimed to understand the lived experience of specialist acute neurovascular nurse practitioners (NPs) working in expanded roles, to build knowledge of the role’s place within acute stroke systems. Methods. A convergent mixed methods research design was used to provide a comprehensive representation of the acute neurovascular NP lived experience. Acute neurovascular NPs completed a demographic, work role, and scope of practice barrier questionnaire, along with the Dempster Practice Behavior Scale (DPBS), followed by semi-structured focus group interviews. Quantitative data were analyzed using SPSS; qualitative data were analyzed with NVivo to identify themes. Quantitative and qualitative data were then integrated to elucidate meta-inferences. Results. A total of 14 acute neurovascular NPs participated, with a median age of 44 years (IQR 38.75, 50.25) years, 85.7% female, and median work experience of 13 years (IQR 4.5, 21). Acute neurovascular NP duties entailed diagnosis, treatment including thrombolysis administration, and ongoing hospital-based patient management. The DPBS revealed a high Autonomy median score of 130 (IQR 120.75, 140.50). Themes from the qualitative data were: 1) Independence (subthemes- work related confidence and clinical leadership); 2) Barriers (subthemes- policy-driven and physician-driven practice restrictions); and 3) Collaboration. Meta-inferences confirmed that expanded role acute neurovascular NPs are highly educated, experienced clinicians with high levels of practice autonomy that is discordant with both practice barriers and scope of practice. Conclusions. As role expansion continues to be driven by physician shortages, acute neurovascular NPs must make clear their legal scope of practice restrictions to ensure regulatory compliance, while advocating for the removal of unnecessary practice barriers.