Role of Nurse Practitioners in Primary Healthcare Settings

This assignment highlights the role of nurse practitioners (NPs) in primary healthcare settings, including their responsibilities, impact on quality of care, and alignment with professional standards. It also discusses the importance of NPs in improving healthcare access and outcomes.

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

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Introduction
A nurse practitioner (NP) is popularly known as Advanced Practice Registered Nurse
(APN). Their role is to conduct the additional responsibilities of the patient care, mainly the
responsibilities those falls outside the scope of the practice of the registered nurses (RN). In
addition to this, NPs also have a duty of prescribing medicines, conducting a detailed
examination of the patients at the time of admission or during the time of emergencies along
with implementation of proper medications like any other clinical practitioners (McCabe et
al., 2016). Moreover, the advanced studies done by NP helps to gain the required expertise in
order to adorn the required duties that are left behind for the discretion of the physicians.
Time and again, it has been highlighted that training given to NPs mainly encompass the
effective prevention of disease, co-ordination of overall process of patients’ care along with
the promotion of optimal health-related outcomes (Naylor &Kurtzman, 2010). The scope of
practice of NP is dedicated by jurisdiction and the registered NPs have the required expertise
of delivering acute care, primary care and speciality care and chronic care to the patients
irrespective of their age or other factors (Naylor &Kurtzman, 2010). Determination of the
quality of the healthcare services delivered to the patients is of utmost important to healthcare
professionals as it helps to ensure proper functioning of the healthcare system and to improve
overall quality of life of the healthcare service users(MacLellan, Levett‐Jones & Higgins,
2015). The following assignment aims to highlight the role of NP under the primary
healthcare settings. This will be elaborated under the evidences extracted from published
research articles. At the end the assignment will attempt to align the Nursing and midwifery
Board of Australia’s (NMBA) professionals’ code of conduct with the NP’s role under the
primary healthcare settings. Finally, the paper will end with discussing the impact of NP
under primary healthcare settings.

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Description of the role
According to Naylor and Kurtzman (2010), nurses represent the single largest group
among health care professionals. The growth of RN workforce is accompanied with increase
in overall number of trained APN. APN represents at least 8% of work-force and plays
distinct roles as nurse anaesthetists, clinical nurse specialists (nurse having advanced skills
and knowledge in the domain of special patient population availing care in primary and acute
care settings), clinical nurse specialists and nurse practitioners (NPs). About 70 to 80% of
advanced practice RN works in primary healthcare like paediatrics, adult health, nurse
midwifery and gerontology.
The main role of NP under primary healthcare settings is to increase overall quality of
care. The study conducted by Naylor and Kurtzman (2010) highlighted that NPs plays an
important role in improving overall quality of care under healthcare settings by decreasing
overall mortality and morbidity. This is followed by increase in the level of patient
satisfaction along with improvement in emotional, physical and social function. The review
conducted by Smolowitz et al. (2015) stated that NPs are assumed to provide active
leadership under primary healthcare settings based on their understanding of patients’ clinical
needs, family and other system priorities. The role of RN under primary healthcare settings
like management of chronic disease, procurement of preventive and episodic care helps to
earn diverse health-related outcomes. Smolowitz et al. (2015) stated that NPs under the US
and Canadian healthcare settings are assigned to perform telephone triage along with
patients’ assessment and documentation of patients’ health status. This helps in improving
overall quality and efficacy of primary healthcare systems along with decrease in overall
healthcare costs. Smolowitz et al. (2015) recommended further education and training of NPs
in order to bring more refinement in the primary healthcare practice. The role of NPs in the
promotion of cost effectiveness in the primary healthcare settings along with improvement in

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overall quality of care is further highlighted in the systematic review conducted by Martin-
Misener e al. (2015). The systematic review showed that NPs is an alternative health care
provider in the ambulatory primary healthcare set up. Diligent role of NPs in the primary
healthcare like documentation of the patients’ symptoms helps in the proper identification of
the clinical priority (both mental and physical priority). The identification of the clinical
priority helps in devising of the patients’ centred care plan and thereby helping to improve
targeted health-related outcome. Application of the patients centred care also increase overall
prognosis of disease. This in turn helps to decrease the length of stay at hospital and thereby
helping to decrease overall cost of care and improvement in the patients’ satisfaction. The
primary healthcare (PHC) settings of Australia, Canada (Alberta, Ontario and Quebec) and
USA highlighted that the primary health care NPs are undergoing transformational change
and thereby helping to bring a positive reform in the PHC settings. The positive healthcare
reform is mainly attributed to change in the interprofessionals dynamics of teamwork. This
helps to promote effective collaboration with the allied healthcare professionals and other
members of the multidisciplinary team under primary healthcare practice like nutritionist,
dieticians, physiotherapists, occupational therapists and midwives and community health
nurses. This increased provision of effective collaboration between the members of the
multidisciplinary team helps to increase person-centred care planning and thus helping
overall quality of care. However, Harriset al. (2016) have stated that under large healthcare
practices, there is less scope to adopt interprofessional collaboration under transformational
leadership style as given by NPs of PHC as here the main leadership style is autocratic
leadership. The systematic review of the randomised control trials conducted by Swanet al.
(2015) stated that safety and overall effectiveness of the primary healthcare can be increased
by eradicating the shortages of NPs under the rural healthcare settings. The study showed that
NPs or the APN mainly have longer face-to-face consultation with the patients and their

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family members in comparison to their family members and this help in highlighting accurate
clinical priority and implementation of patient-centred interventions. NPs demonstrated
nearly equal to better outcomes in comparison to the physician groups for different
physiologic measures along with increase in the level of patients’ satisfaction and decreased
in overall cost of care. In order to highlight the specific roles of NPs under the PHC settings,
Korthuis e al. (2017) conducted a scoping review. The review mainly focused on the role of
NPs in decreasing the addiction towards opioid for pain management. The study found that
proper implementation of the psychological or non-pharmacological interventions under the
PHC settings by NPs helps to reduce the tendency of use of opioid for the management of
pain. This helps to overcome the side effects of opioid. In the maternity settings of the PHC,
NPs also play an important role. The use of the telemedicine by the NP helps to improve the
breastfeeding outcomes. This helped to provide lactation support to a wider group of patients.
It also helped to prevent the barriers that are associated with the attendance of on-site
breastfeeding support groups. Increased tendency of breast feeding helped to improve overall
outcome of infant’s health (Burkhart, 2017).
The systematic review conducted by Buerhaus et al. (2015) highlighted that
projections of shortages of the physicians, increase in the number of number of the aging
population and expansion of insurance have increased the interest in increasing the number of
the primary healthcare nurse practitioners (PCNPs) in the US and in Australia. The number of
PCNPs is higher than the PHC physicians under both the rural and under the urban healthcare
settings. The role of PCNP is to provide care under community healthcare settings and to
treat patients who are insured and work effectively with the vulnerable population. Whether
working independently or in association with the PHC physicians, the presence of PHCNP is
found to increase the primary healthcare access particularly for the vulnerable population and
thereby helping to increase overall health status and decrease in the health inequality

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(Buerhaus et al., 2015). The systematic review conducted by Xueet al. (2016) argued that in
order to increase the capacity of the PHC, the NP must be used effectively in the healthcare
service delivery process. However, the ability of NPs in order to provide care to a
comprehensive extent of their education is moderated by state scope of practice (SOP)
regulations. Removing the restrictions on the NP SOP regulations will help to increase the
healthcare utilization of the population residing in the rural and the vulnerable population.
Standards of practice
The standards of practice execute by NPs is aligned with the RN standards for
practice as published by the Nursing and the Midwifery Board of Australia (NMBA). The
standard 1.1 of NMBA states that it is the duty of the nurses to analyse, access and use the
best available evidences for promoting safe and quality practice (NMBA, 2017). ANP role
also deals with the proper assessment of the evidences while devising care plan for patients.
This will help in the generation of person-centred care plan. 1.5 states that it is the role of the
nurses to make timely and accurate documentation in order to aid the decision making
process(NMBA, 2017). NPs followed rigorous documentation of the patients’ vital signs and
other healthcare needs in order to identify the clinical priority. 1.3 promotes cultural safety
and competence(NMBA, 2017). PHC under NPs encompass promotion of health awareness
under the community health care settings. The main focus of health awareness program under
the community healthcare setting is health-education of the Aboriginals and Torres Strait
Islanders. NPs abide by the transcultural nursing principle in order to conduct culturally safe
educational campaign(MacLellan, Levett‐Jones & Higgins, 2015). Standard 2 states that it is
the duty of the nursing professional to engage in the therapeutic relationship with the patients
and their family members. NPs execute the use of the effective communication skills while
consulting with the patients and their family members. This help to increase the trusted

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relationship with the patients during the course of consultation. This trusted relationship helps
to increase the provision of the therapy adherence and informed consent and thereby helping
to increase patients’ satisfaction(Halcomb et al., 2016). 3.4 state that it is the duty of the
nurses to accept the accountability of the decision-making process. NPs accept the
accountability of the decision-making process during the primary healthcare settings in the
outdoor set-up when the interventions are designed by NPs due to lack of availability of the
doctors. The standard 4.1 expects the nurses to evaluate, monitor and to document the
different interventions, treatments and implement the evidence-based practice(NMBA, 2017).
This will help to improve the outcome of care under the PHC by promoting fast recovery and
decrease the length of stay at the hospital. Quality care is also governed by delivering
counselling along with proper support to the patients about their current condition and self-
management along with co-ordinating services with the other available community health
resources(MacLellan, Levett‐Jones & Higgins, 2015).
Impact of role
NPs mainly deliver primary care under both private and public healthcare settings.
They functions as both independent and collaborative practice arrangement. The mainly take
a lead in the clinical decision making. They also take part in the management of the health
workforce and are accountable for their role in the healthcare practice(Barnes, 2015). Naylor
and Kurtzman (2010) stated that NPs under the primary healthcare settings are known to
bring innovative change in the intervention planning and thus helping to improve overall
outcome of care. NP is known for working directly with the healthcare service users and their
family members. They are also known for diagnosing their health alignments. NPs also holds
the authority to conduct extensive assessment of the physical health, interpretation of the
laboratory tests, conduct counselling with the patients on the services been offered and the

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note down the prescriptions for treating the patients with specific complaints(Barnes, 2015).
Alternatively it can be said that it is imperative for a professional NP to deliver a project
vision for the healthcare organisation and to secure the health care resources for ensuring
continuous quality improvement in the healthcare sectors. Research conducted so far have
helped to highlight that NPs have supreme expertise in delivery high quality, medically
focused care under different sectors of healthcare, with the special mention to PHC. During
the last few years, NPs have been acknowledged as one of the important pillars of the
healthcare teams. Moreover, the number of healthcare facilities and services that utilise their
healthcare expertise is also increasing day by day(Buerhaus et al., 2015).
The experience of NPs in the profession of nurse help them to avail a unique
opportunity to deliver quality healthcare services to the healthcare service users. It must be
noted that nurse practitioner form one of the significant part of the health and social care. The
nursing professionals also work under the PHC for giving care to a diverse range of
population(McCabe et al., 2016). Providing NPs the required authority of executing their
comprehensive range of skills and education will be helpful in building an efficient
workforce that will be helpful in meeting the healthcare needs of the diverse group of
population under the PHC settings. The people who are medically underserved or uninsured
also holds prime importance for NPs in delivering quality care (McCabe et al., 2016).
Buerhaus et al. (2015) are of the opinion that NPs plays a major role in reducing the scarcity
of the healthcare professionals like the remote areas where there is a scarcity of healthcare
physicians. The presence of NPs helps to increase the healthcare access and thus helping to
reduce the health inequalities. In additional to this, NPs also play an important role in the
retail clinical thus helping to uplift overall PHC services(McCabe et al., 2016).

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Conclusion
Thus from the above discussion it can be concluded that NPs are autonomous and
licenced clinicians who plays an important role in increasing overall healthcare access of the
people from diverse group of population with the special mention to the people residing in
the rural communities or are Aboriginals. NPs are mainly responsible to conducting health
check-ups, doing proper documentation of the patients’ records followed by taking notes for
prescriptions and implementation of non-pharmacological interventions and highlighting
other patients’ need by consulting directly with the patients. The presence of Nps helps to
improve the outcome of care under the PHC settings and at the same time helps to reduce
overall cost of care. They also abide by the NMBA code of conduct. Such that, they practice
in a culturally safe manner, stays accountable for the care they provide and also indulge in the
effective communication with the patients for the development of the therapeutic
relationships. Proper education and training must be given to NPs in order to refine the
healthcare workforce strength.

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