ArticleBMJ open2018
National mixed methods evaluation of the effects of removing legal barriers to full practice authority of Dutch nurse practitioners and physician assistants.
Article in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 36 citations in OpenAlex.
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- Pharmacists' perspectives on potential pharmacist prescribing: a nationwide survey in the Netherlands.International journal of clinical pharmacy · 2025Article
- Potential for pharmacist prescribing in primary care: A Dutch citizen perspective.Exploratory research in clinical and social pharmacy · 2024Article
- A survey exploring factors affecting employment of physician associates in Ireland.Irish journal of medical science · 2023Article
- The influence of government policies on the nurse practitioner and physician assistant workforce in the Netherlands, 2000-2022: a multimethod approach study.BMC health services research · 2023Review
- Evaluating task shifting to the clinical technologist in Dutch healthcare: A mixed methods study.PloS one · 2023Article
- Impact of nurse-surgeons on patient-centred outcomes: A systematic review.International journal of nursing studies advances · 2022Review
- The perception of stakeholders on the applicability of nurse-led clinics in the management of rheumatoid arthritis.Rheumatology advances in practice · 2021Article
- Facilitating and motivating factors for reporting reprehensible conduct in care: A study among nurse practitioners and physician assistants in the Netherlands.Journal of evaluation in clinical practice · 2021Article
- Reallocations in acne healthcare: exploring the possible roles and added value of non-physicians by a mixed-methods study design.BMC health services research · 2021Article
- Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review.International journal of integrated care · 2021Article
- Differences in patient population and service provision between nurse practitioner and general practitioner consultations in Swiss primary care: a case study.BMC family practice · 2020Article
- Perceptions of interprofessional collaboration in education of dentists and dental hygienists and the impact on dental practice in the Netherlands: A qualitative study.European journal of dental education : official journal of the Association for Dental Education in Europe · 2020Article
- Nurse prescribing of medicines in 13 European countries.Human resources for health · 2019Article
- An activity analysis of Dutch hospital-based physician assistants and nurse practitioners.Human resources for health · 2019Article
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo evaluate the effects of granting legal full practice authority (FPA) to nurse practitioners (NP) and physician assistants (PA) regarding the performance of specified reserved medical procedures and to support governmental decision-making.
designNationwide mixed methods design with triangulation of quantitative (Pre-post test design) and qualitative data (expert interviews and focus groups).
methodsSurveys focused on the performance of the procedures (monthly number, authorisation mode, consultations and procedural time) and legal cross-compliance requirements (adherence with protocols, competence). Interviews focused on competence, knowledge, skills, responsibilities, routine behaviour, NP/PA role, acceptance, organisational structure, collaboration, consultation, NP/PA positioning, adherence with protocols and resources. Data collection took place between 2011 and 2015.
resultsQuantitative data included 1251 NPs, 798 PAs and 504 physicians. Besides, expert interviews with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 healthcare providers) were held.After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the proportion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs/PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Utilisation of FPA was dependent on the setting, as scepticism of physicians and medical boards hampered full implementation. Legal cross-compliance requirements were mostly fulfilled.
conclusionsInformal practice was legalised. The opportunities to independently perform catheterisations, injections, prescribing, punctures and small surgical procedures were highly used. Care processes were organised more efficiently, services were performed by the most appropriate healthcare provider and conditions were met. This led to the recommendation to continue with FPA.
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