Background: While greater reliance on nurse practitioners in primary healthcare settings can improve service\nefficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both\nregistered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare\nnurse practitioners� integration. This study�s main objective is to examine different structures and mechanisms put\nin place to support the development of primary healthcare nurse practitioner�s practice in different healthcare\nsettings, and develop a practical model for identifying and planning adequate support practices.\nMethods: This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province\nof Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse\npractitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of\nlocation, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based\non the analysis of available documentation in each primary healthcare setting and on semi-structured interviews\nwith key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis\napproaches.\nResults: This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis\ndemonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based,\nmultilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very\ndifferent implementation structures and practices, and different actors were involved at each of the three levels.\nThe results also indicated that nursing departments played a decisive role at all three levels.\nConclusions: Based on these findings, we suggest that support practices should be adapted to each organization�s\nenvironment and experience and be modified as needed throughout the integration process. We also stress the\nimportance of combining this approach with a strong coordination mechanism involving managers who have indepth\nunderstanding of nursing professional roles and scopes of practice. Making primary healthcare nurse\npractitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing\nmanagers could be the key to successful integration.
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