A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia
Abstract
:1. Introduction
“A registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A master’s degree is recommended for entry level.”(p. 72)
2. Materials and Methods
2.1. Design and Settings
2.2. Sampling Process
2.3. Data Collection Procedures
2.3.1. Quantitative Phase
2.3.2. Qualitative Phase
2.4. Ethical Considerations
2.5. Data Analysis
3. Results
3.1. Quantative Results
3.1.1. Sample Characteristics
3.1.2. Supply of Nurse Practitioners
3.1.3. Nurse Practitioners’ Roles
3.1.4. Interest in Becoming Nurse Practitioners
3.2. Qualitative Results
3.2.1. Factor One: Effective Collaboration with Other Staff
“It may be easy to work with nurse practitioners because current nurses have the experience, while nurse practitioners have the information. There would be effective cooperation between experience and information.”(N11)
“There was effective cooperation between nurses who hold a diploma and those who have a bachelor’s degree during the COVID-19 period, especially in the ICU. The same idea will surely be with those who have practitioner level.”(N6)
3.2.2. Factor Two: Better Contribution to Care Quality and Patient Safety
“In every health field, there will be development and progress as long as there is a nurse practitioner specialty because it combines practice and information and is advanced in its nature at the same time.”(N7)
“Nurse practitioners may contribute to changing some of the current ideas and to be leaders. They also have a better and faster intervention and may shorten the time with medical intervention. Yes, they have an important role in improving quality and safety.”(N3)
3.2.3. Factor Three: Better Contribution to Evidence-Based Practice
“Nurse practitioner specialization will have a big role—in my opinion—in improving research in the future.”(N7)
“Nurse practitioners will certainly have a role by virtue of their degree level. Their information will be more deep. They will certainly have a stronger viewpoint, discover errors, and perhaps modify them and develop the workplace.”(N2)
3.2.4. Barrier One: Low Motivation to Become a Nurse Practitioner
“There are not enough stimuli, meaning that the nurse performs several roles or tasks. Some aspects of the job are similar to the doctor’s work and can also work in inpatient or outpatient. There is supposed to be a plan to provide rewarding incentives.”(N1)
“I notice maybe three quarters of the hospital staff don’t know what a nurse practitioner is. Neither diploma nor bachelor’s holders know this specialty. Sometimes if I say I have a nurse practitioner degree, the response comes: What is this specialty?”(N8)
3.2.5. Barrier Two: Unclear Scope of Practice
“I think that the nursing office in the hospital does not recognize the specialty of nurse practitioner yet. They did not give it enough importance like other specialties.”(N8)
“I think the problem is related to the legislative bodies…meaning that they accepted a specific program, but did not make a future plan for the people who will graduate from this program.”(N1)
4. Discussion
4.1. Study Limitations
4.2. Study Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Woo, B.F.Y.; Zhou, W.; Lim, T.W.; Tam, W.S.W. Registered nurses’ perceptions towards advanced practice nursing: A nationwide cross-sectional study. J. Nurs. Manag. 2020, 28, 82–93. [Google Scholar] [CrossRef] [PubMed]
- Hibbert, D.; Aboshaiqah, A.E.; Sienko, K.A.; Forestell, D.; Harb, A.W.; Yousuf, S.A.; Kelley, P.W.; Brennan, P.F.; Serrant, L.; Leary, A. Advancing Nursing Practice: The Emergence of the Role of Advanced Practice Nurse in Saudi Arabia. Ann. Saudi. Med. 2017, 37, 72–78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lamb, A.; Martin-Misener, R.; Bryant-Lukosius, D.; Latimer, M. Describing the leadership capabilities of advanced practice nurses using a qualitative descriptive study. Nurs. Open 2018, 5, 400–413. [Google Scholar] [CrossRef]
- Casey, M.; O’Connor, L.; Rohde, D.; Twomey, L.; Cullen, W.; Carroll, Á. Role dimensions of practice nurses and interest in introducing advanced nurse practitioners in general practice in Ireland. Health Sci. Rep. 2022, 5, e555. [Google Scholar] [CrossRef] [PubMed]
- Liu, C.; Hebert, P.L.; Douglas, J.H.; Neely, E.L.; Sulc, C.A.; Reddy, A.; Sales, A.E.; Wong, E.S. Outcomes of primary care delivery by nurse practitioners: Utilization, cost, and quality of care. Health Serv. Res. 2020, 55, 178–189. [Google Scholar] [CrossRef]
- Htay, M.; Whitehead, D. The effectiveness of the role of advanced nurse practitioners compared to physician-led or usual care: A systematic review. Int. J. Nurs. Stud. Adv. 2021, 3, 100034. [Google Scholar] [CrossRef]
- Buerhaus, P.I.; DesRoches, C.M.; Dittus, R.; Donelan, K. Practice characteristics of primary care nurse practitioners and physicians. Nurs. Outlook 2015, 63, 144–153. [Google Scholar] [CrossRef]
- Chow, S. Nurse Practitioner Fracture Liaison Role: A Concept Analysis. Orthop. Nurs. 2017, 36, 385–391. [Google Scholar] [CrossRef]
- Gardner, G.; Duffield, C.; Doubrovsky, A.; Adams, M. Identifying advanced practice: A national survey of a nursing workforce. Int. J. Nurs. Stud. 2016, 55, 60–70. [Google Scholar] [CrossRef]
- Rosa, W.E.; Fitzgerald, M.; Davis, S.; Farley, J.E.; Khanyola, J.; Kwong, J.; Moreland, P.J.; Rogers, M.; Sibanda, B.; Turale, S. Leveraging nurse practitioner capacities to achieve global health for all: COVID-19 and beyond. Int. Nurs. Rev. 2020, 67, 554–559. [Google Scholar] [CrossRef]
- Almutairi, H.A.; Alharbi, K.N.; Alotheimin, H.K.; Gassas, R.; Alghamdi, M.S.; Alamri, A.A.; Alsufyani, A.M.; Bashatah, A.S. Nurse Practitioner: Is It Time to Have a Role in Saudi Arabia? Nurs. Rep. 2020, 10, 7. [Google Scholar] [CrossRef] [PubMed]
- Alsufyani, A.M.; Alforihidi, M.A.; Almalki, K.E.; Aljuaid, S.M.; Alamri, A.A.; Alghamdi, M.S. Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies. Int. J. Afr. Nurs. Sci. 2020, 13, 100256. [Google Scholar] [CrossRef] [PubMed]
- Smith, L.B. The effect of nurse practitioner scope of practice laws on primary care delivery. Health Econ. 2022, 31, 21–41. [Google Scholar] [CrossRef] [PubMed]
- Gesser-Edelsburg, A.; Cohen, R.; Shahbari, N.A.E.; Hijazi, R. A mixed-methods sequential explanatory design comparison between COVID-19 infection control guidelines’ applicability and their protective value as perceived by Israeli healthcare workers, and healthcare executives’ response. Antimicrob. Resist. Infect. Control 2020, 9, 148. [Google Scholar] [CrossRef]
- Wang, X.; Cheng, Z. Cross-Sectional Studies: Strengths, Weaknesses, and Recommendations. Chest 2020, 158, S65–S71. [Google Scholar] [CrossRef]
- Asefzadeh, S.; Kalhor, R.; Tir, M. Patient safety culture and job stress among nurses in Mazandaran, Iran. Electron. Physician 2017, 9, 6010–6016. [Google Scholar] [CrossRef] [Green Version]
- Lincoln, Y.S.; Guba, E.G. Naturalistic Inquiry. Available online: https://us.sagepub.com/en-us/nam/naturalistic-inquiry/book842 (accessed on 4 November 2022).
- Kwak, S.K.; Kim, J.H. Statistical data preparation: Management of missing values and outliers. Korean J. Anesthesiol. 2017, 70, 407–411. [Google Scholar] [CrossRef]
- Bahari, G.; Alharbi, F.; Alharbi, O. Facilitators of and barriers to success in nursing internship programs: A qualitative study of interns’ and faculty members’ perspectives. Nurse Educ. Today 2022, 109, 105257. [Google Scholar] [CrossRef]
- Tsang, J.L.Y.; Ross, K.; Miller, F.; Maximous, R.; Yung, P.; Marshall, C.; Camargo, M.; Fleming, D.; Law, M. Qualitative descriptive study to explore nurses’ perceptions and experience on pain, agitation and delirium management in a community intensive care unit. BMJ Open 2019, 9, e024328. [Google Scholar] [CrossRef] [Green Version]
- Donelan, K.; DesRoches, C.M.; Dittus, R.S.; Buerhaus, P. Perspectives of physicians and nurse practitioners on primary care practice. N. Engl. J. Med. 2013, 368, 1898–1906. [Google Scholar] [CrossRef]
- Alshammari, M.S.; Alshurtan, R.; Alsuliman, G.; Alshammari, M.; Alhamazani, H.; Alshammry, S.; Dayrit, R.D.; Alkwiese, M. Factors Affecting the Implementation and Barriers to Evidence-Based Practice among Nurse Practitioners in Hail Region, Saudi Arabia. Nurse Media J. Nurs. 2021, 11, 187–196. [Google Scholar] [CrossRef]
- Woo, B.F.Y.; Lee, J.X.Y.; Tam, W.W.S. The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: A systematic review. Hum. Resour. Health 2017, 15, 63. [Google Scholar] [CrossRef] [PubMed]
- Gottlieb, L.N.; Gottlieb, B.; Bitzas, V. Creating Empowering Conditions for Nurses with Workplace Autonomy and Agency: How Healthcare Leaders Could Be Guided by Strengths-Based Nursing and Healthcare Leadership (SBNH-L). J. Healthc. Lead. 2021, 13, 169–181. [Google Scholar] [CrossRef] [PubMed]
- Al-Dossary, R.N. The Saudi Arabian 2030 vision and the nursing profession: The way forward. Int. Nurs. Rev. 2018, 65, 484–490. [Google Scholar] [CrossRef] [PubMed]
- Torrens, C.; Campbell, P.; Hoskins, G.; Strachan, H.; Wells, M.; Cunningham, M.; Bottone, H.; Polson, R.; Maxwell, M. Barriers and facilitators to the implementation of the advanced nurse practitioner role in primary care settings: A scoping review. Int. J. Nurs. Stud. 2020, 104, 103443. [Google Scholar] [CrossRef] [PubMed]
- Aljohani, K.A.; Alamri, M.S.; AL-Dossary, R.; Albaqawi, H.; Hosis, K.A.; Aljohani, M.S.; Almadani, N.; Alrasheadi, B.; Falatah, R.; Almazan, J.; et al. Scope of Nursing Practice as Perceived by Nurses Working in Saudi Arabia. Int. J. Environ. Res. Public Health 2022, 19, 4220. [Google Scholar] [CrossRef] [PubMed]
Characteristics | N | (%) |
---|---|---|
Age (Years) M = 33.44, SD ± 4.94, range: 24–45 | ||
Gender | ||
Male | 8 | (10.4) |
Female | 69 | (89.6) |
Nationality | ||
Saudi | 70 | (90.9) |
Non-Saudi | 7 | (9.1) |
Years of experience | ||
Less than 5 years | 10 | (13.0) |
5 to 10 years | 34 | (44.2) |
More than 10 years | 33 | (42.9) |
Level of education | ||
Diploma | 27 | (35.1) |
Bachelors | 23 | (29.9) |
Higher education | 26 | (33.8) |
Income status | ||
Less than SR 7000 | 7 | (9.1) |
SR 7000 or more | 67 | (87.0) |
Work status | ||
Permanent | 47 | (61.0) |
Contract | 29 | (37.7) |
Work department | ||
Medical ward | 8 | (10.4) |
Surgical ward | 6 | (7.8) |
Critical care units | 18 | (23.4) |
Other departments | 45 | (58.4) |
Previous experience with nurse practitioners | ||
No | 30 | (39.0) |
Yes | 47 | (61.0) |
Interested to becoming a nurse practitioner | ||
No | 17 | (22.1) |
Yes | 60 | (77.9) |
Make Better n (%) | Make Worse n (%) | No Effect n (%) | Don’t Know n (%) | |
---|---|---|---|---|
Safety | 62 (80.5%) | 3 (3.9%) | 5 (6.5%) | 7 (9.1%) |
Timeliness | 52 (67.5%) | 5 (6.5%) | 9 (11.7%) | 11 (14.3%) |
Effectiveness | 61 (79.2%) | 5 (6.5%) | 4 (5.2%) | 7 (9.1%) |
Efficiency, cost-effectiveness | 53 (68.8%) | 7 (9.1%) | 5 (6.5%) | 12 (15.6%) |
Equity | 46 (59.7%) | 7 (9.1%) | 12 (15.6%) | 12 (15.6%) |
Patient-centeredness | 63 (81.8%) | 4 (5.2%) | 4 (5.2%) | 6 (7.8%) |
Healthcare cost | 49 (63.6%) | 7 (9.1%) | 9 (11.7%) | 12 (15.6%) |
Strongly Agree (%) | Agree (%) | Neither Agree nor Disagree (%) | Disagree (%) | Strongly Disagree (%) | N/A (%) | |
---|---|---|---|---|---|---|
NPs should practice to the full extent of their education and training | 44 (57.1%) | 28 (36.4) | 4 (5.2%) | 0 | 0 | 1 (1.3%) |
The charges of the outpatient service provided by NPs should not be different from that of a physician | 32 (41.6%) | 31 (40.3) | 8 (10.4) | 5 (6.5%) | 0 | 1 (1.3%) |
When delivering the same outpatient service as physicians, NPs are able to provide the same quality of service | 32 (41.6%) | 35 (45.5%) | 6 (7.8%) | 2 (2.6%) | 1 (1.3%) | 1 (1.3%) |
NPs should be legally allowed hospital-admitting privileges in outpatient settings | 38 (49.4%) | 29 (37.7%) | 8 (10.4) | 0 | 0 | 2 (2.6%) |
NPs are partners in medical decision making (i.e., make decisions with physicians regarding patient management) | 31 (40.3%) | 35 (45.5%) | 5 (6.5%) | 1 (1.3%) | 1 (1.3%) | 3 (3.9%) |
NPs provide clinical leadership and consultancy in their specific clinical specialty | 31 (40.3%) | 35 (45.5%) | 8 (10.4%) | 0 | 1 (1.3%) | 1 (1.3%) |
NPs lead, train, and mentor nurses | 35 (45.5%) | 29 (37.7%) | 9 (11.7%) | 1 (1.3%) | 1 (1.3%) | 2 (2.6%) |
NPs promote research/quality improvement project | 36 (46.8%) | 30 (39%) | 7 (9.1%) | 1 (1.3%) | 1 (1.3%) | 2 (2.6%) |
NPs promote organization level changes | 35 (45.5%) | 32 (41.6%) | 7 (9.1%) | 1 (1.3%) | 0 | 2 (2.6%) |
NPs advocate for nurses | 35 (45.5%) | 31 (40.3%) | 8 (10.4%) | 1 (1.3%) | 0 | 2 (2.6%) |
NPs improve the public image of the nursing profession | 34 (44.2%) | 34 (44.2%) | 3 (3.9%) | 1 (1.3%) | 2 (2.6%) | 3 (3.9%) |
Variable | B | S.E. | Wald | Significance | Odds Ratio | 95% CI |
---|---|---|---|---|---|---|
Constant | −1.10 | 2.91 | 0.14 | |||
Perspectives toward NP Roles | 0.03 | 0.01 | 5.73 | 0.017 | 1.04 | 1.01–1.07 |
Age | 0.003 | 0.07 | 0.003 | 0.96 | 1.003 | 0.88–1.14 |
Gender | 0.18 | 1.37 | 0.01 | 0.89 | 1.19 | 0.08–17.5 |
Years of Experience | −0.21 | 0.42 | 0.25 | 0.61 | 0.81 | 0.35–1.85 |
Education | −0.33 | 0.44 | 0.56 | 0.44 | 0.72 | 0.30–1.69 |
Income | −0.39 | 1.28 | 0.09 | 0.76 | 0.67 | 0.05–8.35 |
Work Status | 0.24 | 0.62 | 0.14 | 0.70 | 1.26 | 0.37–4.29 |
Work Department | 0.18 | 0.32 | 0.31 | 0.57 | 1.20 | 0.63–2.28 |
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Kerari, A.; Bahari, G.; Aldossery, N.; Qadhi, O.; Alghamdi, A. A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia. Healthcare 2023, 11, 146. https://doi.org/10.3390/healthcare11010146
Kerari A, Bahari G, Aldossery N, Qadhi O, Alghamdi A. A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia. Healthcare. 2023; 11(1):146. https://doi.org/10.3390/healthcare11010146
Chicago/Turabian StyleKerari, Ali, Ghareeb Bahari, Nahed Aldossery, Omaimah Qadhi, and Alya Alghamdi. 2023. "A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia" Healthcare 11, no. 1: 146. https://doi.org/10.3390/healthcare11010146
APA StyleKerari, A., Bahari, G., Aldossery, N., Qadhi, O., & Alghamdi, A. (2023). A Mixed-Methods Sequential Explanatory Study of the Factors That Impact Nurses’ Perspectives toward Nurse Practitioners’ Roles in Saudi Arabia. Healthcare, 11(1), 146. https://doi.org/10.3390/healthcare11010146