Finding Florence: Shedding Light on Nurse Practitioners’ Professional Responsibility
AIM: This thesis explored how NPs perceive, develop and enact their professional responsibility with respect to NPs’ independency, their expertise and their role development.
METHOD: A qualitative approach was designed to collect and analyse policy documents, opinion articles, research articles, interviews, focus group discussions, reflective case studies written by students and observations in the NP practices. Purposeful sampling of NP students and NP graduates was chosen to study information-rich cases.
FINDINGS: In the Netherlands, the NP role was presented as a solution for healthcare and workforce problems. Efficiency arguments seemed most influential. Opinions of NPs themselves were underrepresented; taking up new responsibilities was driven by the wish to improve patient care. While most physicians were willing to delegate tasks to NPs, they still wished to retain final responsibility for medical care. The case studies revealed that the NP students felt responsible for the monitoring of patients’ health status, attending to psychosocial problems, emphasizing compliance, and optimizing the family’s role as informal caregivers. At the same time, they struggled to understand the complexities of their patients’ needs, and they had difficulty applying their knowledge and skills to complex medical, psychological, and social problems. After some years the NP graduates found themselves successful in the medical extension of two different nursing roles, i.e. continuity of medical care for hospitalized patients in acute and intensive care settings, and being responsible for continuity of care for chronic patients in outpatient clinics. Observations in the NP practices showed that the NPs enacted the monitoring of patient’s treatment as their prime responsibility while moving patients’ illness perceptions to the background of attention, which was not conducive to self-management support of their patients.
DISCUSSION AND CONCLUSION: To develop a broader perception on professional responsibility, a thorough understanding of people’s responses to changes in their health is a necessity for nurse practitioners. NPs are expected to use their nursing competencies on an advanced level of care, which is the ability to use theory, research evidence, observations and experience to tailor nursing practice in complex and challenging situations. This implies meeting patient’s needs, including physical, psychosocial, and spiritual needs (the need to feel useful, the need for hope, and the need for human dignity).

Dit proefschrift beschrijft hoe verpleegkundig specialisten hun professionele verantwoordelijkheid in de directe zorgverlening aan patiënten opvatten, ontwikkelen en vormgeven. Het eerste deel verkent het debat in Nederland over deze nieuwe zorgprofessionals en de invloed van het debat op de kansen om als verpleegkundig specialist te mogen functioneren. Het tweede deel richt zich op de mogelijkheden van reflectie bij het ontwikkelen van nieuwe expertise. Het derde deel onderzoekt de transities die verpleegkundigen doormaken in hun ontwikkeling naar verpleegkundig specialist, hoe zij de nieuwe rol willen vormgeven en hoe zij deze realiseren in de praktijk.