Nurse Practitioner and Physician Collaboration in the Long-Term Care Setting: Secondary Analysis of a Scoping Review.

Abstract

Objective: Over the past decade, the role of nurse practitioners (NPs) in long-term care home (LTCH) settings has significantly expanded. Despite this trend, gaps have been identified in the description of collaborative practices between NPs and physicians in the LTCH sector. This study aimed to characterize the elements of collaboration between NPs and physicians in LTCH settings by applying the "Structured Collaborative Practice Core Model."

Design: A secondary analysis of a scoping review that focuses on literature where NPs and physicians collaboratively provided care in LTCH settings.

Methods: The initial scoping review followed the Joanna Briggs Institute methodology and PRISMA-ScR guidelines and included 60 peer-reviewed articles. Data relevant to the 7 core elements of the Structured Collaborative Practice Core Model-responsibility and accountability, coordination, communication, cooperation, assertiveness, autonomy, and mutual trust and respect-were extracted and analyzed. We included articles that described at least 1 element in the analysis.

Results: Twenty-nine articles were included in the secondary analysis. The analysis revealed that coordination (n = 25) and communication (n = 23) were the most frequently reported elements. Coordination was often highlighted through descriptions of care delivery organization and decision-making processes, where NPs provided continuous oversight and referred complex cases to physicians. Effective communication pathways, such as joint rounding and face-to-face meetings, were essential for successful collaboration. In contrast, assertiveness (n = 3) was the least frequently discussed element.

Conclusion and implications: Applying the Structured Collaborative Practice Core Model to the existing literature on NP and physician collaboration in LTCH settings underscores the importance of effective coordination and communication. Future work needs to investigate the historical and hierarchical dynamics influencing the relationship. Understanding these elements will inform strategies to optimize collaborative efforts, ultimately improving patient care outcomes in LTCH settings. The unique dynamics of NP and physician care models need to be considered.