Clinician experience, perceptions, and acceptance of paediatric complex care nurse practitioner roles

Background: Nurse practitioner (NP) roles are implemented to increase access to care in response to rising demands and pressures in the health system, yet little evaluation is undertaken to assess how these new roles integrate with services. Aim: To identify health professionals’ experiences, perceptions, and acceptance of NP roles in complex care medical subspecialties within a paediatric tertiary hospital and health services. Methods: The AUSPRAC validated survey was distributed in both electronic and paper forms to a purposeful cohort of multidisciplinary health professionals (n = 208) working directly or collaboratively with both established NPs and novice/in training NPs. Nine medical subspecialties were represented including metabolic, immunisation and oncology. Two reminders were sent to non-responders. All NP roles within nine medical specialties were evaluated. Data were tabulated and descriptively analysed. Findings: Ninety-two responses were received (response rate 44%). Services with highest representation were Immunisation (71%), Metabolic Medicine and Palliative Care (45%) each. Responses were received from medical (42%) nursing (30%) and other healthcare providers (27%) including allied health clinicians. Most respondents agreed they understood NP roles (89%), agreed their introduction into the service had been a success (85%) and that NP services met the needs of the patients (91%). Some (9%) respondents reported they feared NP prescribing increased the risk of incorrect treatment with 7% not trusting NPs to diagnose correctly and some (15%) worried that NPs did not have the necessary knowledge to prescribe. Free text comments were generally positive and supportive of the roles, with few negative statements. Discussion: While most NP roles were positively viewed, breakdowns in communication processes affected understanding and acceptance of some NP roles. Clearly defining the scope, purpose and benefits of NP roles should be communicated to individual teams and across whole organisations. Conclusion: NP roles are largely well accepted within this paediatric tertiary service, which demonstrates a shift in culture from research undertaken at the turn of the century. Attention to implementation factors may improve successful integration of new roles into services.