[Do clinical nurse practitioners affect the working environment and the quality of care?]

This correlational study examined the influence of a new kind of advanced nurse practitioner in Switzerland with the role of providing complex care, consulting with patients and families, fostering the growth of staff, enhancing team functioning and contributing to nursing knowledge through research. Based on systems theory the perception of staff about their work environment and their motivation to engage in continuing education as well as the patients' satisfaction with care and trust in the nurses were measured outcomes. Instruments were constructed for this study, tested and standardized. Data from three hospital units with an advanced practitioner were compared to three units without a practitioner similar in size, staffing, patient acuity and system of nursing care. Staff reported better guidelines for care, more frequent feedback and better professional advice on units with an advanced practitioner while the quality of communication, professional stimulation and support with difficult patients was comparable on all units. Motivation to further one's education was generally high. In units with an advanced practitioner, there was increased interest in psychosocial topics, and the availability of such literature was better. Patients were highly satisfied in all units, but there was a slight difference in patient trust. It was somewhat easier for patients on units with an advanced practitioner to ask the nurses questions. The study suggested that the advanced practitioner should contribute most by strengthening team cohesion through constructive feedback as well as enhancing a climate for continuing learning through better resources, guided case discussions and opportunities for shared problem solving.