Integration of nurse practitioners using a change management framework: the way forwardGrainne Lowe A , Virginia Plummer B C E and Leanne Boyd D
A School of Nursing & Midwifery, Deakin University, Geelong, Vic. 3220, Australia.
B Monash University, McMahons Road, Frankston, Vic. 3199, Australia.
C Peninsula Health, Hastings Road, Frankston, Vic. 3199, Australia.
D Cabrini, 154 Wattletree Road, Malvern, Vic. 3144, Australia.
E Corresponding author. Email: email@example.com
Australian Health Review 41(5) 553-560 https://doi.org/10.1071/AH16068
Submitted: 12 March 2016 Accepted: 7 August 2016 Published: 7 October 2016
Objective The aim of the present study was to investigate and describe the application of a change management theoretical framework in relation to nurse practitioner (NP) role integration.
Methods A survey formed Phase 1 of a broader mixed-methods study to explore perceptions of the change process involved with integrating NPs into Australian health care settings. The stakeholder participants were NPs, nurse managers and nurse policy advisers.
Results Key themes were identified adding information about how NPs, nurse managers and nurse policy advisers perceive the integration of NPs into Australian healthcare. The themes correlate to the components of organisational change management necessary to embed NPs into the healthcare workforce.
Conclusions Healthcare reform is a complex organisational change. Alignment of several key elements is required for the process to be successful. A change management proposal for reframing organisations provides an apt framework for use in the Australian context of reforming workforce to integrate NPs into healthcare teams. The theoretical framework proposes that multiple lenses be applied to change processes, to integrate NPs into the workforce and highlights the need for exceptional leadership throughout such endeavours.
What is known about the topic? NPs provide safe and efficient care to patients, often in settings where access to health care is limited. NPs have been identified as a key strategic workforce reform initiative to address some of the known healthcare gaps.
What does this paper add? This paper adds information about how NPs, nurse managers and nurse policy advisers perceive progress of the integration of NPs into healthcare settings. The findings are contextualised within an organisational change framework and highlight the complexity of healthcare reform.
What are the implications for practitioners? The findings provide a novel approach for managing workforce reform and identify the components of change management necessary to embed NPs into the healthcare workforce.
References Attree M, Flinkman M, Howley B, Lakanmaa RL, Lima-Basto M, Uhrenfeldt L. A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom*/England. J Nurs Manag 2011; 19 786–802.
| A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom*/England.CrossRef | 21899632PubMed |
 Hudson P, Marshall A. Extending the nursing role in emergency departments: challenges for Australia. Australas Emerg Nurs J 2008; 11 39–48.
| Extending the nursing role in emergency departments: challenges for Australia.CrossRef |
 Gardner G, Chang A, Duffield C. Making nursing work: breaking through the role confusion of advanced practice nursing J Adv Nurs 2007; 57 382–91.
| Making nursing work: breaking through the role confusion of advanced practice nursingCrossRef | 17291202PubMed |
 Health Workforce Australia. National health workforce innovation and reform strategic framework for action 2011–2015. Adelaide: Health Workforce Australia; 2011.
 Bolman L, Deal T. Reframing organizations: artistry, choice and leadership. 5th edn. San Francisco: Jossey-Bass; 2013.
 Lowe G. Integration of nurse practitioners into Australian healthcare settings: a mixed methods study of the structural, human resource, political and cultural implications for organisational change. PhD Thesis, Monash University, Melbourne; 2014. Available at: http://arrow.monash.edu.au/vital/access/services/Download/monash:151103/THESIS01 [verified 20 August 2016].
 Lowe G. Scope of emergency nurse practitioner practice: where to beyond clinical practice guidelines? Aust J Adv Nur 2010; 28 74–82.
 Trypuc J, Hudson A. Waiting lists and nursing. Nurs Leadersh 2005; 18 36–40.
| Waiting lists and nursing.CrossRef |
 DiCenso A, Auffrey L, Bryant-Lukosius D, Donald F, Martin-Misener R, Matthews S, Opsteen J. Primary health care nurse practitioners in Canada. Contemp Nurse 2007; 26 104–15.
| Primary health care nurse practitioners in Canada.CrossRef | 18041990PubMed |
 Gardner G, Gardner A, Middleton S, Della P, Kain V, Doubrovsky A. The work of nurse practitioners. J Adv Nurs 2010; 66 2160–9.
| The work of nurse practitioners.CrossRef | 20636472PubMed |
 Rodriguez KA, Goodhue CJ, Upperman JS. Pediatric nurse practitioner implementation of a pediatric trauma continuity clinic utilizing the ‘medical home’ model. J Trauma Nurs 2010; 17 64–6.
| Pediatric nurse practitioner implementation of a pediatric trauma continuity clinic utilizing the ‘medical home’ model.CrossRef | 20559050PubMed |
 Browne A, Tarlier D. Examining the potential of nurse practitioners from a critical social justice perspective Nurs Inq 2008; 15 83–93.
| Examining the potential of nurse practitioners from a critical social justice perspectiveCrossRef | 18476851PubMed |
 Nursing and Midwifery Board of Australia (NMBA). Nurse and midwife registrant data: March 2016. 2016. Available at: http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx [verified 20 August 2016].
 Considine J, Fielding K. Sustainable workforce reform: case study of Victorian nurse practitioner roles. Aust Health Rev 2010; 34 297–303.
| Sustainable workforce reform: case study of Victorian nurse practitioner roles.CrossRef | 20797361PubMed |
 Jennings N, Lee G, Chao K, Keating S. A survey of patient satisfaction in a metropolitan emergency department: comparing nurse practitioners and emergency physicians. Int J Nurs Pract 2009; 15 213–18.
| A survey of patient satisfaction in a metropolitan emergency department: comparing nurse practitioners and emergency physicians.CrossRef | 19531080PubMed |
 Harvey C. Legislative hegemony and nurse practitioner practice in rural and remote Australia. Health Sociol Rev 2011; 20 269–80.
 Lowe G, Plummer V, Boyd L. Perceptions of NP Roles in Australia: Nurse Practitioners, Managers, and Policy Advisors. J Nurse Pract 2016; 12 e303–e310.
 Sasnett B, Clay M. Leadership styles in interdisciplinary health science education. J Interprof Care 2008; 22 630–8.
| Leadership styles in interdisciplinary health science education.CrossRef | 19012143PubMed |
 White L. Funding debate: who pays for nursing. Nurs Rev 2013; 4 pp 20–22
 Flitcroft K, Gillespie J, Salkeld G, Carter S, Trevena L. Getting evidence into policy: the need for deliberate strategies? Soc Sci Med 2011; 72 1039–46.
| Getting evidence into policy: the need for deliberate strategies?CrossRef | 21419539PubMed |
 Fitzgerald A Teal G
 Productivity Commission. Australia’s health workforce research report. Canberra: Government of Australia; 2005.
 Street D, Cossman J. Does familiarity breed respect? Physician attitudes toward nurse practitioners in a medically underserved state. Am Acad Nurse Practitioners 2010; 22 431–9.
| Does familiarity breed respect? Physician attitudes toward nurse practitioners in a medically underserved state.CrossRef |
 Katz A, MacDonald J. Physician perceptions of nurse practitioners: the nurse practitioner role has been met with mixed reviews. A qualitative study from Manitoba reveals the perceptions of some physicians regarding this relatively new relationship on the health care team. Can Nurse 2002; 98 28–31.
| 12238224PubMed |