Developing a nurse practitioner to work in residential aged care: A qualitative evaluative study

Background: The effectiveness of advanced practice nurses, such as nurse practitioners (NP), has been demonstrated across several measures of health status and family satisfaction, for older adults in residential aged care settings. There is limited evidence, however, about how best to develop NP from the existing workforce in this setting. Aim: To describe the structures and processes that both enabled and were barriers to the development of the nurse practitioner role. Methods: Qualitative descriptive methods, involving semistructured interviews and focus groups, were employed to explore participant perspectives of the structures and processes involved in developing a nurse practitioner candidate (NPC) (student). Study participants included older adult residents, visiting General Practitioners (GPs), the NPC and facility staff, including nurses and personal care assistants. Content analysis of data categorised as structural and processes enablers and barriers was undertaken. Findings: Nine residents and 25 staff participated in individual interviews or focus groups. Physical structures required for appropriate functioning of the NP role included integrated practice management software, however, social structures such acceptance by existing staff and visiting GPs were initially a barrier but improved over time. Efficient collaboration, enhanced assessment and surveillance of older adults, and improved communication were identified as the key processes enabling the development of the nurse practitioner role from candidate to endorsed nurse practitioner. Discussion and conclusion: The development of a NPC onsite in a residential aged care setting improved communication with GPs and local hospital emergency staff and supported facility staff through capacity building and providing access to primary care onsite. These improvements could stimulate policymakers to access the potential of their existing registered nursing staff, interested in becoming NP to improve primary care for older populations while undertaking their education and beyond.