NURSING ASSIGNMENT

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Nurses who are highly qualified and are experienced are known as Advanced Nurse
Practitioners (ANP). The ANPs possess the ability to investigate, assess, diagnose and prescribe
the correct intervention to the patients. According to the NHS Greater Glasgow and Clyde more
than 100 ANPs are working across the world based at primary care to intensive care unit. The
role of the Advanced Nurse Practitioner is thus to provide complete clinical care to the patients
rather than caring for a specific condition (Nhsggc.org.uk 2019). In other words, it should be
mentioned that ANP should not be confused with a specialization degree; it is rather a level of
practice (Hendry and Walker 2004). Further, ANPs possess the authority of a clinical leader and
can independently take decisions in the best interest of the patient. Further, it should also be
mentioned in this regard that ANPs also own the authority to refer, admit or discharge a patient
within relevant clinical areas. However, the role of an Advance Nurse Practitioners is often
misunderstood or is unclear to the physicians. The common notion treats ANPs as an assistant to
the Physician which leads to communication gap and at the same time poor job satisfaction
among the Nurse practitioners. Therefore, this paper intends to evaluate the perception about
ANP among the physicians and devise appropriate strategies to improve their level of
understanding about the role of an ANP within a healthcare setting.
Literature Review:
In order to evaluate the perception of the Physicians in relation to the role of the ANPs
within a healthcare setting, an exhaustive literature review would be conducted. The literature
review would be based upon the articulated research question mentioned below:

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RQ1: What are the common perceptions about the role of ANPs among Physicians within Saudi
Arabia?
RQ2: How do ANPs contribute to the healthcare system?
RQ3: Where do ANPs stand within the healthcare system?
Search Strategy:
In order to conduct the review, the electronic bases Google Scholar, CINAHL, PubMed
and MedLine were thoroughly searched by using relevant key terms and the research papers that
satisfied the exclusion and inclusion criteria were considered relevant for the literature review.
Exclusion Criteria:
According to Parahoo (2014), scanning the electronic databases exposes a wide gamut of
literatures which need to be filtered on the basis of specific criteria so as to narrow down the
search and include only relevant papers. The exclusion criteria thus includes the characteristics
that are used to exclude irrelevant papers that do not substantially address the research question.
The following exclusion criteria were included while conducting the search:
 Papers that were published prior to 2003 were not considered
 Papers that were published in foreign languages other than English were excluded
 Papers that could not be accessed completely and only the abstract part was accessible
was also excluded
Inclusion Criteria:

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The inclusion criteria on the other hand constitutes of the set of characteristics that serve
as checklists to include the literatures in the paper (Parahoo 2014). The following list of
inclusion criteria were considered which included the following:
 Papers published between 2003-2018 were included for the review
 Papers that were published in English language were considered for the review
 Papers that were aligned to the medical context of Saudi Arabia were included
 Papers that were fully accessible were considered for the review
Key terms:
Key terms are short phrases that are relatable to the research question and help in
retrieving literatures that are connected to the central concept of the research paper. The key
terms that were used to conduct a search on the electronic database included the following terms:
Physician perception, ANP, Saudi Arabia, Role of ANP, Healthcare system, NP, healthcare
environment
Review:
A research study conducted by Dalton (2013) focused on evaluating the perception of the
junior physicians at their first year of placement and RNs about the role of ANPs The researcher
conducted a qualitative cross-sectional study and adapted an interpretative research philosophy.
The sample size considered for the research included six junior doctors, six ward nurses and six
ANPs and the researcher conducted a semi structure interview to evaluate the response of the
participants (Dalton 2013). Typically, the findings were segregated under four themes and the
gathered responses revealed diverse understanding of the role of the ANPs during the day shift

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and at night shift. While care professionals working at the night shift seemed to have a clear
understanding about the role of the ANPs, the care professionals working at the day shift seemed
to lack knowledge about the role of the ANPs and identified them as assistants to the physician.
According to the researcher the absence of a bleep filtering policy during the day was identified
as the reason for the role confusion among the care professionals.
A study conducted by Kemp (2016), investigated the effect of the presence of the
Advanced Nurse practitioners on reducing the rate of referral within a healthcare setting. The
researchers conducted a prospective observational study. The sample size considered by the
researchers included a total of 842,000 people, who attended the four mass gatherings and 652
people presented for medical care on the basis of self-referral. The collected data was analyzed
using the statistical interpretive methods of one-tailed Fisher’s Exact Test and Phi analysis. The
central findings revealed a significant reduction in the number of patient referral to external
health care organizations. Also, a significant reduction in the number of ambulatory referral was
also noted. At the same time, the researchers also concluded that involved of an ANP within the
healthcare facility could significantly reduce the number of patient referrals.
A research study conducted by Donelan et al. (2016), indicated the fact that the U.S
health care system at present is suffering from a shortage of primary care physicians. In order to
address the shortage of primary care physicians, policy makers have proposed the idea of
expanding the scope of Nurse practitioners in order to meet the increasing patient demands. The
researchers conducted a national survey, where 972 clinicians participated with 467 Nurse
practitioners and 505 Physicians. The survey questionnaire included parameters such as scope of
work, practice characteristics and perception and attitude towards expanding the scope of
practice (Donelan et al. 2016). The survey analysis typically included responses of Physicians

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who stated working for longer hours and seeing more number of patients and being placed at a
high scale against Nurse practitioners being paid less for the same work. Also, the survey
responses revealed that a total of 80.9% Nurse practitioners worked in association with a
physician (Donelan et al. 2016). On the other hand, only 41.4% physicians reported to working
with a Nurse practitioners (Donelan et al. 2016). The perception of the Nurse practitioners
revealed the belief that Nurse practitioners must be given the authority to lead medical homes,
manage hospital admission and discharge and should be paid equal to that of the physicians. On
response to the question that whether or not physicians were able to perform better patient
assessments and provide quality in terms of patient care, 66.1% physicians agreed, however,
75.3% nurse practitioners disagreed (Donelan et al. 2016). Therefore, it can be said that nurses
and physicians are not clear about their different set of roles within a healthcare setting. In
addition to this, the legislation to expand the scope for ANPs is controversial with no clear
understanding among the healthcare professionals.
As researched by Kutzleb et al. (2015), the NP care model and framework has been
deemed to be effective in providing care to the patients. The researchers used the evidence based
Lowa Model to devise a framework focusing on the population problem. The NP care model was
used within the New Jersey Medical Center which was primarily concerned with treating patients
with chronic illness. The program critically aimed patients who were suffering from cardiac
failure and were discharged but at the same time were identified as high-risk patients, who were
potential candidate for readmissions. The sample size comprised of 312 adult patients in between
20 to 89 years of age who were admitted to the hospital for the treatment of cardiac failure. The
NPs under the Healthy Heart Initiative targeted factors such as lifestyle factors, medication,
nutrition and diet and disease management. The results significantly stated a positive outcome by

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reducing the 30 day readmission rate (Kutzleb et al. 2015). In addition to this, the research also
revealed improvement in patient outcome and increased patient satisfaction, suggesting that NP
care model was effective in providing effective care delivery.
Another report by del-Pino Jones et al. (2019), revealed the perception of physicians in
relation to the Nurse Practitioners and evaluated their attitude towards the role of nurse
practitioners. The researchers collected data by using a mixed methodology survey which
comprised of both open as well as closed questions to evaluate the perception of the physicians
towards the role of Nurse practitioners and physician assistants in care teams. A total of 25
participants who were physicians having an experience of 6.2 years of practice participated in the
survey. The survey revealed positive responses by Physicians in relation to the role of NPs in
providing care to the patients, improve patient efficacy and elevate the level of patient
satisfaction (Pino Jones et al. 2019). Also, the survey responses indicated that physicians
preferred to work with NPs with multiple years of experience and stated that it helped in
improving patient outcome.
Also, in the words of Teresa et al. (2017), the care model has now shifted from
assessing greater number of patients on hourly basis to improved patient outcome and level of
satisfaction. Nurse practitioners are therefore required to continuously upgrade their skillset and
knowledge in order to render effective care to the patients. The review conducted by Teresa et
al. (2017) had helped in significantly pointing out the three important factors that govern the
empowerment process of the Nurses and it comprises of naming, claiming and explaining. The
first step naming comprises of naming a personal practice philosophy and the subsequent step
includes, the NP claiming or accessing resources in order to practice in accordance to the
philosophy and the final step involves providing an explanation to the stakeholders and working

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together to improve care delivery as well as patient outcome. The author have established clear
guidelines for nursing professionals to focus on their nursing philosophy and enhance their scope
of practice.
Ramira et al. (2018), estimated that the shortage of physicians within the U.S healthcare
system would almost reach up to 91.000 by the end of 2020 on account of an increase in the
population. In order to address the shortage, the healthcare system has been supporting the
expansion in role of advance nurse practitioners. A major proportion of the Nurse practitioners
comprise of immigrant students who are unable to practice medicine within the United Nations
but assume the role of NPs. The researchers of the study conducted an online survey in order to
access the challengers, barriers and satisfiers that affect the transition from physicians to that of
NPs. The sample size included 38 participants, out of which 11 participants participated in focus
group discussions (Ramira et al. 2018). The participants majorly included women whose
countries of origin comprised of Mexico, Phillipines, China, Iraq, Pakistan and Russia. The data
represented two themes, personal theme and program themes. Personal themes included
balancing roles, peer support, persistence at time of challenging opportunities, confidence to
acquire success, comprehensive thinking skills and gratitude as well as opportunities. On the
other hand, program theme included, constant changes, competence with the clinical faculty,
acquiring an understanding of the U.S educational system and understanding the concept of
shared responsibility (Ramira et al. 2018). The researchers therefore evaluated the positive as
well as the negative aspect of the themes and highlighted the factors that should be kept in mind
while designing curriculum programs so as to promote a smooth transition in foreign students.
Also, according to the survey of Nurse Practitioners conducted by the Staff care in
association with the American association of Nurse practitioners a total of 222 complete survey

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responses were evaluated. The findings revealed that, NPs are positive about their profession.
Also, the survey results presented a positive response about job satisfaction. However, the survey
responses described NPs as overworked and overextended and a 75% positive response to the
universal shortage of care professionals as mentioned in the report published by Staff care’s
Advanced Practice Division on behalf of ANPF (Content.hcpro.com 2019). However, the
response to NPs being able to lead a team was only 51%, which indicated that NPs are yet to
acquire autonomy and practice to their full potential professionals as mentioned in the report
published by Staff care’s Advanced Practice Division on behalf of ANPF (Content.hcpro.com
2019).
According to Hibbert et al. (2017), the concept of advanced nursing practice had been in
the healthcare system since 1890S. However, the concept had been readily taken up by the
Western countries by the 1960S primarily on account of the increasing healthcare needs and
unmet treatment demands of the rural population. It should be mentioned in this context that
initially NPs used the medical model to diagnose and treat a medical condition. However, the
role of ANP has changed and at present care is imparted on the basis of the holistic care model.
The role and responsibilities of the advanced practice Nurses has evolved and is not merely
restricted to assisting the physicians. ANPs, are now competent to care for patients and provide
care based on clinical expertise, education, research as well as effective leadership (Hibbert et
al. 2017). However, the concept of advanced nurse practitioners have not yet been assimilated
into the healthcare system of Saudi Arabia and the nation is yet to understand the defined role of
an ANP and legislate their validity within the healthcare delivery system.
Therefore, it can be mentioned that the exhaustive review of the literatures highlighted a
number of common themes. The themes included a lack of understanding among the ANPs about

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their specific professional roles. As mentioned in the published report by the Staff care’s
Advanced Practice Division on behalf of ANPF, nursing professionals were yet to acquire
autonomy and practice according to their complete potential. Also, the findings of the research
conducted by Dalton (2013) mentioned that RNs and junior physicians were not clear about the
role of ANP within a healthcare setting. On the contrary the study conducted by Donelan et al.
(2016) suggested that for the similar amount of work load and responsibility towards patient
care, there was an existing disparity in the pay scale of the professionals. However, the research
study by Kutzleb et al. (2015) suggested that the implementation of NP care model managed by a
team of nursing professionals could effectively help in reducing the rate of hospitalization of
patients with cardiac disorders. Pino Jones et al. (2019) supported the findings of Kutzleb et al.
(2015) and revealed that experienced physicians preferred working with ANPs and believed that
collaborative practice led to positive outcome. Also, according to Kempt et al. (2016), the
involvement of ANP within a healthcare setting could significantly help in the number of patient
referrals. However, the research conducted by Ramira et al. (2018) significantly highlighted that
despite the existence of the concept of ANP, the concept has yet not been assimilated into the
healthcare system of Saudi Arabia. Teresa et al. (2017) in her paper critically mentioned the
considerations that Nurses should be aware of while drafting their nursing philosophy for
practice.
The research papers considered in the review include significant sample size which
ensures the generalization of the results. However, the papers have not discussed
recommendation strategies that could help in disseminating awareness about the role of ANP to
the Physicians and other accessory healthcare professionals. Therefore, research should be

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conducted to explore awareness strategies so as to absorb the concept of ANP within the
healthcare system of Saudi Arabia.
Conclusion:
Therefore, to conclude it can be said that the literature review critically helped in
reviewing a number of important research papers that identify the role and responsibilities of the
Advanced Nurse Practitioners in providing effective care to patients and improving patient
outcome. The review helped in evaluating the perception of the physicians with regard to role of
ANPs within a healthcare setting. The Physician’s perceive ANPs as assistants and are confused
about their roles. However, a number of papers have also pointed out the effectiveness of the
advanced nursing professionals in providing holistic care to the patients and reduce the rate of
recurrent hospitalization. However, the concept about ANPs is yet to be assimilated into the
healthcare system of Saudi Arabia which should be done at the earliest in order to cater to the
healthcare needs of the growing population at a time when there is an acute shortage of
physicians.

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References:
Content.hcpro.com 2019. [online] Content.hcpro.com. Available at:
http://content.hcpro.com/pdf/content/296954.pdf [Accessed 27 Feb. 2019].
Dalton, M. A. 2013. Perceptions of the advanced nurse practitioner role in a hospital
setting. British Journal of Nursing, 22(1), 48-53.
del Pino-Jones, A., Wolfe, B., Wimmer, K., Bowden, K., Rosenthal, L., Nogar, C., ... and
Cumbler, E. (2019). Physician Perceptions of Advanced Practice Providers on Hospitalist
Teams. The Journal for Nurse Practitioners, 15(2), e37-e40.
Donelan, K., DesRoches, C. M., Dittus, R. S. and Buerhaus, P. (2013). Perspectives of
physicians and nurse practitioners on primary care practice. New England Journal of
Medicine, 368(20), 1898-1906.
Hendry, C and Walker, A. 2004. Priority setting in clinical nursing practice: literature
review. Journal of advanced nursing, 47(4), 427-436.
Hibbert, D., Aboshaiqah, A. E., Sienko, K. A., Forestell, D., Harb, A. W., Yousuf, S. A., ... and
Leary, A. (2017). Advancing nursing practice: The emergence of the role of advanced practice
nurse in Saudi Arabia. Annals of Saudi medicine, 37(1), 72.
Kemp, A.E., 2016. Mass-gathering Events: the role of advanced nurse practitioners in reducing
referrals to local health care agencies. Prehospital and disaster medicine, 31(1), pp.58-63.

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Kutzleb, J., Rigolosi, R., Fruhschien, A., Reilly, M., Shaftic, A. M., Duran, D. and Flynn, D.
(2015). Nurse practitioner care model: meeting the health care challenges with a collaborative
team. Nursing Economics, 33(6), 297-305.
Nhsggc.org.uk 2019. NHSGGC : Advanced Nurse Practitioners. [online] Nhsggc.org.uk.
Available at: https://www.nhsggc.org.uk/about-us/professional-support-sites/nurses-midwives/
advanced-nurse-practitioners/# [Accessed 27 Feb. 2019].
Parahoo, K., 2014. Nursing research: principles, process and issues. Macmillan International
Higher Education.
Ramira, M. L., Peraza-Smith, G. B., McLeod, R. and Clark, M. J. 2018. CHALLENGES,
BARRIERS, AND SATISFIERS OF FOREIGN EDUCATED PHYSICIANS WITH THE
FAMILY NURSE PRACTITIONER ROLE IN THE UNITED STATES. Journal of Cultural
Diversity, 25(1).