ArticleBMJ open2019
Substituting physicians with nurse practitioners, physician assistants or nurses in nursing homes: a realist evaluation case study.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed.
- How Government Policies and Organisational and Sectoral Circumstances Influence Nurse Practitioner and Physician Assistant Employment and Training: A Realist Analysis Using Surveys.Journal of advanced nursing · 2026Article
- Implementation of the Nursing Associate in the NHS: A Rapid Realist Synthesis to Understand Mechanisms of Integration and Workforce Development.Journal of clinical nursing · 2026Review
- Article
- Advanced practice nurses' daily practices delivering primary care to residents in long-term care facilities: a qualitative study.BMC primary care · 2024Article
- Perceptions of general practitioners towards the services provided by advanced practice nurses: a cross-sectional survey in France.BMC health services research · 2023Article
- Effects of care of multimorbid patients in general practices by advanced practice nurses (FAMOUS): study protocol for a nonrandomized controlled trial.BMC health services research · 2023Article
- Frailty nurse and GP-led models of care in care homes: the role of contextual factors impacting Enhanced health in care homes framework implementation.BMC geriatrics · 2023Article
- Nurse Practitioners Navigating the Consequences of Directives, Policies, and Recommendations Related to the COVID-19 Pandemic in Long-Term Care Homes.Journal of applied gerontology : the official journal of the Southern Gerontological Society · 2022Article
- Article
- [Transfer of Physicians' Tasks to Nurses in the Care of People with Dementia].Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) · 2022Article
- Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes.International journal of environmental research and public health · 2021Review
- The Effects of Case-Based Teaching in Nursing Skill Education: Cases Do Matter.Inquiry : a journal of medical care organization, provision and financingArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesThis study aimed to gain insight into how substitution of elderly care physicians (ECPs) by nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs) in nursing homes is modelled in different contexts and what model in what context contributes to perceived quality of healthcare. Second, this study aimed to provide insight into elements that contribute to an optimal model of substitution of ECPs by NPs, PAs or RNs.
designA multiple-case study was conducted that draws on realist evaluation principles.
settingSeven nursing homes in the Netherlands
participantsThe primary participants were NPs (n=3), PAs (n=2) and RNs (n=2), working in seven different nursing homes and secondary participants were included; ECPs (n=15), medical doctors (MDs) (n=2), managing directors/managers/supervisors (n=11), nursing team members (n=33) and residents/relatives (n=78). DATA COLLECTION: Data collection consisted of: (1) observations of the NP/PA/RN and an ECP/MD, (2) interviews with all participants, (3) questionnaires filled out by the NP/PA/RN, ECPs/MDs and managing directors/managers and (4) collecting internal policy documents.
resultsAn optimal model of substitution of ECPs seems to be one in which the professional substitutes for the ECP largely autonomously, well-balanced collaboration occurs between the ECP and the substitute, and quality of healthcare is maintained. This model was seen in two NP cases and one PA case. Elements that enabled NPs and PAs to work according to this optimal model were among others: collaborating with the ECP based on trust; being proactive, decisive and communicative and being empowered by organisational leaders to work as an independent professional.
conclusionsCollaboration based on trust between the ECP and the NP or PA is a key element of successful substitution of ECPs. NPs, PAs and RNs in nursing homes may all be valuable in their own unique way, matching their profession, education and competences.
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