Barriers and facilitators for successful integration of nurse practitioners into interdisciplinary care teams

Abstract

<p><strong>Introduction.</strong As the Affordable Care Act provides an opportunity for the previously uninsured to gain coverage, the disparity between those needing care and those providing care grows.It's well established nurse practitioners can reduce this disparity, but some organizations are ill-prepared to properly implement them. An interprofessional approach to patient care can face conflict due to professions from various backgrounds collaborating; this is magnified in primary care where patient needs are complex and diverse, requiring care from multiple disciplines.</p> <p><strong>Aims/Objectives.</strong> The purpose of this review is to explore the barriers and interventions for successful NP integration to healthcare teams. Research aims are to study the evidence related to autonomy, empowerment, and physician oversight on NP practice; role ambiguity and incivility in healthcare teams; and interventions at the educational and professional levels to promote successful integration.</p> <p><strong>Methods</strong> An integrative review of the literature was performed using CINAHL and Medline databases. Limits were set to include primary sources published within the last five years; however, after an adequate number of articles were found, the search was expanded to ten years to support the theoretical framework. All primary sources used were approved by the Institutional Review Board, and any conflict of interests were reviewed to avoid bias. Studies that achieved rigor through diverse sampling and data analysis were prioritized.</p> <p><strong>Results.</strong> The most commonly cited barriers to integration were threats to NP autonomy or empowerment, such as physician oversight and restrictive payer policies; and team conflict, primarily due to role ambiguity. Incivility and NPs was also researched; however, there is insufficient research. Facilitators to integration were interprofessional education; organizational policies to increase empowerment; and advanced practice nurses in administrative roles.</p> <p><strong>Conclusions.</strong> The United States' expanding and aging population has highlighted the primary care provider shortage. Barriers, such as scope of practice limitations, payer policy restrictions, and role ambiguity undermine autonomous practice. Without organizational change at both educational and professional levels, optimal utilization of NPs will not be attained due to decreased job satisfaction, inefficient interprofessional care teams, and suboptimal patient care.</p>