Descriptive, cross-country analysis of the nurse practitioner workforce in six countries: Size, growth, physician substitution potential

BMJ Open

Volumn 6, Issue 9, 2016, Pages

  Maier, Claudia B ^a,b   Barnes, Hilary ^a   Aiken, Linda H ^a   Busse, Reinhard ^b  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

^b TECHNISCHE UNIVERSITÄT BERLIN   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; AUSTRALIA; CANADA; CLINICAL PRACTICE; HEALTH CARE DELIVERY; HEALTH CARE NEED; HUMAN; IRELAND; MEDICAL EDUCATION; NETHERLANDS; NEW ZEALAND; NURSE PRACTITIONER; PATIENT CARE; PHYSICIAN; PRIMARY MEDICAL CARE; SCOPE OF PRACTICE; UNITED STATES; WORKFORCE; ECONOMICS; MANPOWER; PRIMARY HEALTH CARE; REGRESSION ANALYSIS; SUPPLY AND DISTRIBUTION; TRENDS;

AUSTRALIA; CANADA; HUMANS; IRELAND; NETHERLANDS; NEW ZEALAND; NURSE PRACTITIONERS; PHYSICIANS; PRIMARY HEALTH CARE; REGRESSION ANALYSIS; UNITED STATES;

EID: 85020062431     PISSN: None     EISSN: 20446055     Source Type: Journal    
DOI: 10.1136/bmjopen-2016-011901     Document Type: Article

References (85)

1. Cometto G, Boerma T, Campbell J, et al. The Third Global Forum: framing the health workforce agenda for universal health coverage. Lancet Glob Health 2013;1:e324–5.
2. World Health Organization. A universal truth: no health without a workforce. Third Global Forum on Human Resources for Health Report. Report No.: Forum Report, Third Global Forum on Human Resources for Health. Global Health Workforce Alliance and World Health Organization, November 2013.
3. OECD. Health workforce policies in OECD countries: right jobs, right skills, right places. Paris, 2016.
4. International Council of Nurses. International Council of Nurses: definition and characteristics for nurse practitioner/advanced practice nursing roles. Geneva, 2002 (updated October 2014; cited April 2016). https://acnp.org.au/sites/default/files/33/definition_of_apn-np. pdf
5. World Health Organization. Task shifting to tackle health worker shortages. WHO/HSS/200703, 2007.
6. World Health Organization. Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. Geneva: World Health Organization, 2008.
7. Stanik-Hutt J, Newhouse RP, White KM, et al. The quality and effectiveness of care provided by nurse practitioners. J Nurse Pract 2013;9:492–500.e13.
8. Martinez-Gonzalez NA, Tandjung R, Djalali S, et al. Effects of physician-nurse substitution on clinical parameters: a systematic review and meta-analysis. PLoS ONE 2014;9:e89181.
9. Martinez-Gonzalez NA, Djalali S, Tandjung R, et al. Substitution of physicians by nurses in primary care: a systematic review and meta-analysis. BMC Health Serv Res 2014;14:214.
10. Martinez-Gonzalez NA, Rosemann T, Tandjung R, et al. The effect of physician-nurse substitution in primary care in chronic diseases: a systematic review. Swiss Med Wkly 2015;145:w14031.
11. Mundinger MO. Advanced-practice nursing—good medicine for physicians? N Engl J Med 1994;330:211–14.
12. Martin-Misener R, Bryant-Lukosius D, Harbman P, et al. Education of advanced practice nurses in Canada. Nurs Leadersh (Tor Ont) 2010;23 Spec No:61–84.
13. Gagan MJ, Boyd M, Wysocki K, et al. The first decade of nurse practitioners in New Zealand: a survey of an evolving practice. J Am Assoc Nurse Pract 2014;26:612–19.
14. Ter Maten-Speksnijder A, Grypdonck M, Pool A, et al. A literature review of the Dutch debate on the nurse practitioner role: efficiency vs. professional development. Int Nurs Rev 2014;61:44–54.
15. MacLellan L, Higgins I, Levett-Jones T. Medical acceptance of the nurse practitioner role in Australia: a decade on. J Am Assoc Nurse Pract 2015;27:152–9.
16. Begley C, Elliott N, Lalor J, et al. Differences between clinical specialist and advanced practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). J Adv Nurs 2013;69:1323–37.
17. NHS Education for Scotland. Advanced Nursing Practice Toolkit. Current issues in regulation 2012. September 2015. http://www.advancedpractice.scot.nhs.uk/regulatory-guidance/current-issues-in-regulation.aspx
18. Chamberlain P, Brown CH, Saldana L. Observational measure of implementation progress in community based settings: the Stages of Implementation Completion (SIC). Implement Sci 2011;6:116.
19. Pulcini J, Jelic M, Gul R, et al. An international survey on advanced practice nursing education, practice, and regulation. J Nurs Scholarsh 2010;42:31–9.
20. Delamaire ML, Lafortune G. Nurses in advanced roles: A description and evaluation of experiences in 12 developed countries. OECD Health Working Paper 2010;54 (DELSA/HEA/WD/HWP (2010)5).
21. Heale R, Rieck Buckley C. An international perspective of advanced practice nursing regulation. Int Nurs Rev 2015;62:421–9.
22. Maier CB. The role of governance in implementing task-shifting from physicians to nurses in advanced roles in Europe, U.S., Canada, New Zealand and Australia. Health Policy 2015;119:1627–35.
23. Carney M. Regulation of advanced nurse practice: its existence and regulatory dimensions from an international perspective. J Nurs Manag 2016;24:105–14.
24. Freund T, Everett C, Griffiths P, et al. Skill mix, roles and remuneration in the primary care workforce: who are the healthcare professionals in the primary care teams across the world? Int J Nurs Stud 2015;52:727–43.
25. Spetz J, Fraher E, Li Y, et al. How many nurse practitioners provide primary care? It depends on how you count them. Med Care Res Rev 2015;72:359–75.
26. Hooker RS, Brock DM, Cook ML. Characteristics of nurse practitioners and physician assistants in the United States. J Am Assoc Nurse Pract 2016;28:39–46.
27. Kleinpell R, Goolsby MJ. American Academy of Nurse Practitioners National Nurse Practitioner Sample Survey: focus on acute care. J Am Acad Nurse Pract 2012;24:690–4.
28. Doescher MP, Andrilla CHA, Skillman SM, et al. The contribution of physicians, physician assistants, and nurse practitioners toward rural primary care findings from a 13-state survey. Med Care 2014;52:549–56.
29. Sangster-Gormley E, Martin-Misener R, Downe-Wamboldt B, et al. Factors affecting nurse practitioner role implementation in Canadian practice settings: an integrative review. J Adv Nurs 2011;67:1178–90.
30. Lowe G, Plummer V, Boyd L. Nurse practitioner roles in Australian healthcare settings. Nurs Manag (Harrow) 2013;20: 28–35.
31. Richardson G, Maynard A. Fewer doctors? More nurses? A review of the knowledge base of doctor-nurse substitution. York: Centre for Health Economics, York Health Economics Consortium, University of York, 1995. Contract No.: 135.
32. Laurant M, Reeves D, Hermens R, et al. Substitution of doctors by nurses in primary care. Cochrane Database Syst Rev 2005;(2): CD001271.
33. Advisory Committee on Medical Manpower Planning (Capaciteitsorgaan). The 2013 Recommendations for Medical Specialist Training. In the medical, dental, clinical, technological and mental health areas of training. Utrecht, 2013 (cited September 2015). http://www.capaciteitsorgaan.nl/Portals/0/capaciteitsorgaan/publicaties/Capaciteitsplan%202013/DEFINITIEF%20hoofdrapport% 20engels%20compl.pdf
34. OECD Health Statistics. OECD Health Statistics 2015. Definitions, sources and methods. Metadata. OECD, November 2015. Report No.
35. The Joanna Briggs Institute. The Joanna Briggs Institute Reviewers’ Manual 2015. Methodology for JBI scoping reviews. The Joanna Briggs Institute (JBI), 2015.
36. Maier CB, Aiken LH. Task-shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study. Eur J Public Health 2016. In press.
37. Kaiser Family Foundation. Total number of nurse practitioners, by gender. State Health Facts: Kaiser Family Foundation, 2015 (cited August 2015). http://kff.org/other/state-indicator/total-number-ofnurse-practitioners-by-gender/
38. American Association of Nurse Practitioners. AANP—about us—historical timeline. American Association of Nurse Practitioners (AANP), 2015 (cited December 2015). https://www.aanp.org/about-aanp/historical-timeline
39. U.S. Bureau of Labor Statistics. Occupational Employment and Wages, May 2014. 29-1171 Nurse Practitioners. Bureau of Labor Statistics (BLS), 2014 (cited December 2015). http://www.bls.gov/oes/current/oes291171.htm.
40. U.S. Bureau of Labor Statistics. Occupational Employment and Wages, May 2012. 29-1171 Nurse Practitioners. Bureau of Labor Statistics (BLS), 2012 (cited December 2015). http://www.bls.gov/oes/current/oes291171.htm.
41. U.S. Bureau of Labor Statistics. Occupational Employment and Wages, May 2013. 29-1171 Nurse Practitioners. Bureau of Labor Statistics (BLS), 2013 (cited December 2015). http://www.bls.gov/oes/current/oes291171.htm.
42. Armstrong R, Hall BJ, Doyle J, et al. Cochrane update. ‘Scoping the scope’ of a Cochrane review. J Public Health (Oxf) 2011;33:147–50.
43. Cacchione PZ. The evolving methodology of scoping reviews. Clin Nurs Res 2016;25:115–19.
44. OECD. Population Statistics. OECD.Stat. 2015 (cited December 2015). http://stats.oecd.org/Index.aspx?DatasetCode=POP_FIVE_ HIST
45. OECD. Healthcare Resources: Physicians. OECD.Stat. 2015 (cited December 2015). http://stats.oecd.org/index.aspx?DataSetCode= HEALTH_STAT
46. Dutch health professional register (BIG register). Numbers [Cijfers] of health professionals. Dutch Ministry of Health, Welfare and Sports, 2015 (cited December 2015). https://www.bigregister.nl/overbigregister/cijfers/
47. Rowland D. Demographic methods and concepts. New York: Oxford University Press, 2003.
48. Reinhardt UE, Hussey PS, Anderson GF. Cross-national comparisons of health systems using OECD data, 1999. Health Aff (Millwood) 2002;21:169–81.
49. Brownson RC, Boehmer TK, Luke DA. Declining rates of physical activity in the United States: what are the contributors? Annu Rev Public Health 2005;26:421–43.
50. Anderson GF, Reinhardt UE, Hussey PS, et al. It’s the prices, stupid: why the United States is so different from other countries. Health Aff (Millwood) 2003;22:89–105.
51. Canadian Institute for Health Information. Regulated Nurses, 2014. Health workforce database. Canadian Institute for Health Information, 2015 (cited November 2015). https://secure.cihi.ca/estore/productFamily.htm?locale=en&pf=PFC2898&lang=en
52. Nursing and Midwifery Board of Ireland. Statistics. Register statistics 2014. 2015 (cited November 2015). http://www.nursingboard.ie/en/statistics.aspx
53. Nursing and Midwifery Board of Australia. Statistics. 2015 June 2015. Report No (cited December 2015). http://www.nursingmidwiferyboard.gov.au/About/Statistics.aspx.
54. Nursing Council of New Zealand. Annual report 2015. Wellington, New Zealand: 2015.
55. U.S. HRSA National Center for Health Workforce Analysis. Highlights from the 2012 National Sample Survey of Nurse Practitioners. Rockville, MD: U.S. Department of Health and Human Services, 2014.
56. OECD. OECD Health Statistics 2015. Definitions, sources and methods. Physicians licensed to practice OECD. OECD Health Statistics, July 2015 (cited November 2015). http://www.oecd.org/health/health-data.htm.
57. OECD. OECD Health Statistics 2015. Definitions, sources and methods. Professionally active physicians. OECD, OECD Health Statistics, 2015.
58. Nursing Council of New Zealand. Report of the Nursing Council of New Zealand for the year ended 31 March 2005. Presented to the Minister of Health pursuant to Section 134 of the Health Practitioners Competence Assurance Act 2003. Wellington, New Zealand, 2005.
59. Nursing Council of New Zealand. Report of the Nursing Council of New Zealand for the year ended 31 March 2006. Presented to the Minister of Health pursuant to Section 134 of the Health Practitioners Competence Assurance Act 2003. Wellington, New Zealand, 2006.
60. Nursing Council of New Zealand. Report of the Nursing Council of New Zealand for the year ended 31 March 2007. Presented to the Minister of Health pursuant to Section 134 of the Health Practitioners Competence Assurance Act 2003. Wellington, New Zealand, 2007.
61. Nursing Council of New Zealand. Annual report 2009. Wellington, New Zealand, 2009.
62. Nursing Council of New Zealand. Annual report 2010. Wellington, New Zealand, 2010.
63. Nursing Council of New Zealand. Annual report 2011. Wellington, New Zealand, 2011.
64. Nursing Council of New Zealand. Annual report 2012. Wellington, New Zealand, 2012.
65. Nursing Council of New Zealand. Annual report 2013. Wellington, New Zealand, 2013.
66. Nursing Council of New Zealand. Annual report 2014. Wellington, New Zealand, 2014.
67. Nursing Council of New Zealand. Report of the Nursing Council of New Zealand for the year ended 31 March 2008. Presented to the Minister of Health pursuant to Section 134 of the Health Practitioners Competence Assurance Act 2003. Wellington, New Zealand, 2008.
68. Spitzer WO, Sackett DL, Sibley JC, et al. The Burlington randomized trial of the nurse practitioner. N Engl J Med 1974;290:251–6.
69. van der Biezen M, Schoonhoven L, Wijers N, et al. Substitution of general practitioners by nurse practitioners in out-of-hours primary care: a quasi-experimental study. J Adv Nurs 2016;72:1813–24.
70. Wijers N, van der Burgt R, Laurant M. Verpleegkundig Specialist biedt kansen. Onderzoeksrapport naar de inzet van de verpleegkundig specialist op de spoedpost in Eindhoven. [Specialist Nursing offers opportunities. Research report into the use of the specialist nurse at the emergency station in Eindhoven]. Nijmegen: IQ healthcare, UMC St Radboud; Eindhoven: KOH Foundation, 2013. https://www.stichtingkoh.nl/cms_file.php?fromDB=834&forceDownload.
71. Laurant M. Out of hours primary care. International Innovation, 2013 (cited December 2015). http://rcpsc.medical.org/publicpolicy/imwc/Out_Of_Hours_Primary_Care_Interview_Miranda_Laurant.pdf
72. DiCenso A, Bryant-Lukosius D, Martin-Misener R, et al. Factors enabling advanced practice nursing role integration in Canada. Nurs Leadersh (Tor Ont) 2010;23 Spec No:211–38.
73. Minto R. Barriers on nurse practitioner journey. Nurs N Z 2008;14:4.
74. Begley C, Murphy K, Higgins A, et al. Policy-makers’ views on impact of specialist and advanced practitioner roles in Ireland: the SCAPE study. J Nurs Manag 2014;22:410–22.
75. Scanlon A, Cashin A, Bryce J, et al. The complexities of defining nurse practitioner scope of practice in the Australian context. Collegian 2016;23:129–42.
76. Cashin A. Collaborative arrangements for Australian nurse practitioners: a policy analysis. J Am Assoc Nurse Pract 2014;26:550–4.
77. Parliament of New Zealand. Misuse of Drugs Amendment Regulations 2014. 2014/199. 2014 (cited December 2015). http://www.legislation.govt.nz/regulation/public/2014/0199/latest/DLM6156029.html?search=qs_regulation%40deemedreg_Misuse+of +drugs+act_resel_25_h&p=1.
78. van Meersbergen D. Task-shifting in the Netherlands. World Med J 2011;57:126–30.
79. Phillips SJ. 28th annual APRN legislative update: advancements continue for APRN practice. Nurse Pract 2016;41:21–48.
80. Kroezen M, van Dijk L, Groenewegen PP, et al. Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a systematic review of the literature. BMC Health Serv Res 2011;11:127.
81. Government of Canada. Controlled Drugs and Substances Act. New Classes of Practitioners Regulations. Canada Gazette. 2012;146. (cited December 2015). http://www.gazette.gc.ca/rp-pr/p1/2012/2012-05-05/html/reg1-eng.html.
82. Australian Government. Health Legislation Amendment (Midwives and Nurse Practitioners) Act 2010. No. 29, 2010. C2010A00029. 2010 (cited December 2015). https://www.legislation.gov.au/Details/C2010A00029.
83. Phillips SJ. 27th Annual APRN legislative update: advancements continue for APRN practice. Nurse Pract 2015;40:16–42.
84. Ono T, Lafortune G, Schoenstein M. Health workforce planning in OECD countries: a review of 26 projection models from 18 countries. OECD Health Working Papers. 2013 October 2015 (cited October 2015); No. 62.
85. American College of Physicians. Nurse practitioners in primary care. Philadelphia: American College of Physicians, 2009.