The Nature of the Relationship Between Comprehensive Primary Care Nurse Practitioners and Physicians: A Case Study in Ontario.
Abstract
The purpose of this thesis was threefold – First to investigate the
emergence from the existing health system of nurse practitioners as a
new occupation. Second to make sense of how nurse practitioners
developed as primary care providers in the province of Ontario. Third to
understand the nature and development of the intra-professional
relationship between primary care nurse practitioners and physicians in
local practice settings. I used a case study approach, with both historical
(document review) and empirical (ethnography and interview)
components. The empirical data was analyzed from an interpretive
perspective using thematic analysis. A number of theoretical perspectives
were drawn on, including Kingdon’s Agendas, Alternatives and Public
Policy model, Abbott’s Occupational Jurisdiction model, Van de Ven et al’s
Innovation Journey model, and Closure Theory.
The study makes 3 contributions to new knowledge. First it documents the
unfolding of events and actions over time, and thus serves as a historical
summary. Second it adds an analysis of the case of nurse practitioners as
an emergent occupation to the existing body of sociological analyses of
professions. Third, it provides insight into how nurse practitioner -
physician relationships are impacted at the local level because nurse
practitioners are obligated to develop a relationship with a physician in
order to be able to deliver comprehensive primary care services.
The empirical component of the thesis analyzes and describes the nature
of this relationship at a practice level. It also describes the use of
‘workarounds’ to bypass legislated restrictions in nurse practitioners’
scope of practice. It analyzes how structural differences in the manner of
regulation, payment, and employment status between nurse practitioners
and family physicians contribute to different styles of practice and
perpetuate the hierarchical relationships between nurses and physicians.
This knowledge has potential generalization to other emerging
occupations, such as physician assistants and paramedics
Authors
Eby, Donald HaroldCollections
- Theses [3711]