Role of Nurse Practitioners in Primary Healthcare Settings

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