Integration of nurse practitioners into Australian healthcare settings: a mixed methods study of the structural, human resource, political and cultural implications for organisational change

There is evidence in the literature supporting the benefits of Nurse Practitioner (NP) roles in healthcare settings, from both Australian and international perspectives. Since the potential of NP roles in Australia began to gain serious attention in 1998, some success with integration has been evident. The full potential of NP roles however, remains under utilised across Australian healthcare settings, despite calls for health workforce reforms as a priority to improve the delivery of healthcare services. The aim of this study was to explore the perceived benefits of and support for NP roles in Australia from NP, nurse manager and nurse policy adviser perspectives. A further purpose was to determine the nature of the implications of NP role integration for organisational structure, human resource management, as well as organisational, political and cultural perspectives. The central research question driving the study was: “What are the organisational, human resources, political and cultural implications associated with the integration of NP roles into healthcare settings?” A mixed methods study was conducted over two separate but related phases: an initial quantitative phase, which informed a second qualitative phase. A survey questionnaire was the method of data collection for Phase 1, whilst Phase 2 consisted of semi-structured interviews. A total of 176 participants were involved in Phase 1, from a random sample of NPs, nurse managers and nurse policy advisers across Australian states and territories. A purposeful sub-sample from the Phase 1 participants comprised the participants for Phase 2, with a total of seventeen interviews (18 participants in total) undertaken. An organisational change theoretical framework – Reframing organisations – was used to underpin the conduct of this study. The results indicate that although there is a general sense of positive regard and improved patient outcomes with the addition of the NP role, additional supports are required to further develop this initiative. A number of strategies highlighted by participants as being necessary in order to improve the further growth and sustainable integration of NP roles across multiple healthcare settings. In terms of the application of the Reframing organisations theoretical framework, it was identified that organisational support structures were required to champion NP roles; adequate recognition of the nursing workforce was essential; political leadership and sponsorship were fundamental; and respect for and cultural awareness between professional groups was essential. This study adds to the current body of NP literature by providing an understanding of the perceptions of the role from a variety of nursing perspectives: NPs, nurse managers and nurse policy advisers. Further, these perceptions are explained through further analysis to show the possibilities for organisational efficiency with adequate establishment processes and institutional supports