Registered nurses' perspective of nurse practitioners: A mixed-methods study

To understand what registered nurses (RNs) know about the nurse practitioner (NP) role, and factors affecting RN perspectives toward NPs.

One issue hindering the integration of NPs into healthcare systems is poor RN-NP relationships. This relationship has been understudied where the NP role has been recently introduced.

This study used an explanatory sequential design. A cross-sectional survey was disseminated to RNs to identify knowledge and feelings regarding NPs and factors influencing their perspectives. Based on survey results, semistructured interviews were conducted and analyzed using thematic analysis. Quantitative and qualitative results were integrated to identify converging, diverging, and complementary results. This study adheres to the Checklist of Mixed-Methods Elements in a Submission to Advance the Methodology of Mixed-Methods Research.

There were 277 survey respondents. The factors impacting perspectives toward NPs were age, exposure to NPs, years of experience, and level of education. Seven themes arose from the qualitative data: exposure to NPs, delineation of NP scope of practice, characterizations of NPs, acceptance of the role, advantages of NPs, cultural aspects, and effects of higher education. Quantitative and qualitative results converged in nearly all instances.

To improve the RN-NP relationship, RNs must understand the NP role. RNs who have worked directly with NPs usually express the benefits of NP care for patients and care team members.

To promote the integration of NPs into care teams, it is important to expose RNs to the NP role through education or work experience.

Upstream approaches to improve the RN-NP relationship include educating students about the NP role, offering clinical rotations with NPs, and organizational messaging promoting the RN-NP collaboration.