Professional | Case 1 | Case 2 | Case 3 | Case 4 | Case 5 | Case 6 | Case 7 |
NP | PA | NP | NP | RN | RN | PA | |
Working experience in current professional role | 22 months | 55 months | 50 months | 26 months | 72 months | 25 months | 74 months |
Type of unit | Dementia special care unit (n=1) | Geriatric rehabilitation unit (n=1) | Geriatric rehabilitation unit (n=1) | Dementia special care unit (n=2) | Unit for residents with physical disabilities and dementia special care unit (n=4) | Dementia special care unit (n=8) | Unit for residents with physical disabilities and dementia special care unit (n=3) |
Reason to employ provider | Among others the shortage of ECPs | Among others the shortage of ECPs | Among others the shortage of ECPs | To enhance continuity and quality and retain costs | To reduce the workload of the ECPs | Demedicalisation | Among others the shortage of ECPs |
Vision on substitution | – | – | If possible; tasks should be performed by a professional of lower level | NPs are autonomous medical providers | – | The employment of RNs corresponds with the vision of demedicalisation | – |
Number of collaborating doctor(s) | 1 ECP | 1 ECP | 1 ECP | 1 ECP | 4 ECPs | 2 medical doctors | 2 ECPs |
Type of collaboration with doctor(s) | Shared responsibility ECP does not work at another unit | ECP supports the PA ECP works at another unit | Shared responsibility ECP works at other units | ECP supports the NP ECP works at another unit | Shared responsibility ECPs work at other unit(s) except for one | Shared responsibility Medical doctors work at other units | ECPs support the PA ECPs work at other units |
Structural and/or ad hoc meetings with doctor(s) | Often ad hoc | Structural and minimal ad hoc | Structural and often ad hoc | Structural and often ad hoc | Dependent on the ECP: minimal to often ad hoc meetings | Often ad hoc | Structural and minimal ad hoc |
Level of autonomy | The ECP checks and/or approves the acts of the NP The NP provides wound care autonomous | Fully autonomous | Mostly autonomous Together with the ECP: complex situations, general rounds and multidisciplinary meetings | Fully autonomous | Medical domain: the ECPs check the acts of the RN afterwards or the RN works under supervision Nursing domain: autonomous | Medical domain: under supervision Nursing domain: autonomous | Fully autonomous |
Number of residents | 102 | 12 | 20 | 60 | 199 | 56 | 68 |
Tasks |
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Prescribing medication* | Yes, under supervision of the ECP | Yes, autonomous | Yes, autonomous if competent | Yes, autonomous ECP receives an email | Making proposals to the ECP In exceptional situations checked by the ECP afterwards or under supervision of an ECP | Making proposals to the medical doctors | Yes, autonomous |
Official documents within the organisation |
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Peers in the organisation | 2 NPs | None | 3 NPs | 4 NPs | 4 RNs | 17 RNs | 1 PA |
Member of which team | Medical | Medical | Medical | Medical | Medical | Nursing | Medical |
COPD, chronic obstructive pulmonary disease; DM, diabetes mellitus; ECP, elderly care physician; NP, nurse practitioner; PA, physician assistant; RN, registered nurse.
Prescribing medication is one of the so-called ‘reserved procedures’ described in the Individual Healthcare Professions Act that is mostly performed in nursing homes. In the Netherlands, NPs and PAs are authorised to indicate and perform some of the so-called ‘reserved procedures’, which were initially only reserved for physicians.