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BMC Health Serv Res. 2019 Nov 21;19(1):882. doi: 10.1186/s12913-019-4731-8.

New understanding of primary health care nurse practitioner role optimisation: the dynamic relationship between the context and work meaning.

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Faculty of Social Sciences, Université Laval, Quebec City, Canada.
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec City, Canada.
Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec City, Canada.
Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada.
Department of Nursing Sciences, Université du Québec à Rimouski, Rimouski, Canada.
Département de gestion, d'évaluation et de politique de santé, École de santé publique, Université de Montréal, Montréal, Canada.
Chaire de recherche du Canada sur la transformation, le design et l'amélioration des systèmes de santé, Montréal, Canada.



Optimising health professionals' contribution is an essential step in effective and efficient health human resources utilisation. However, despite the considerable efforts made to implement advanced practice nursing roles, including those in primary care settings (PHCNP), the optimisation of these roles remains variable. In this investigation, we report on the subjective work experience of a group of PHCNPs in the province of Quebec (Canada).


We used Giddens' structuration theory to guide our study given its' facilitation of the understanding of the dynamic between structural constraints and actors' actions. Using a qualitative descriptive study design, and specifically both individual and focus group interviews, we conducted our investigation within three health care regions in Quebec during 2016-2017.


Forty-one PHCNPs participated. Their descriptions of their experience fell into two general categories. The first of these, their perception of others' inadequate understanding and valuing of their role, included the influence of certain work conditions, perceived restrictions on professional autonomy and the feeling of being caught between two professional paradigms. The second category, the PHCNPs' sense of engagement in their work, included perspectives associated with the specific conditions in which their work is situated, for example, the fragility of the role depending on the particular clinic/s in which they work or on the individuals with whom they work. This fragility was also linked with certain health care reforms that had been implemented in Quebec (e.g., legislation requiring greater physician productivity).


Several new insights emerged, for example, the sense of role fragility being experienced by PHCNPs. The findings suggest an overarching link between the work context, the meaning attributed by PHCNPs to their work and their engagement. The optimisation of their role at the patient care level appears to be influenced by elements at the organisational and health system context levels. It appears that role optimisation must include the establishment of work environments and congruent health context structures that favour the implementation and deployment of new professional roles, work engagement, effective collaboration in interprofessional teams, and opportunities to exercise agency. Further research is necessary to evaluate initiatives that endeavour to achieve these objectives.


Delivery of health care; Nurse practitioners; Optimisation of health professional role; Primary health care nurse practitioners; Work meaning

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