The nurse in general practice: beyond the thresholds

360° scan thresholds nurse in a general practice

The barriers to the recruitment of a nurse in a general practice are numerous and sometimes high. The decision-making process prior to the recruitment of a nurse in a general practice takes on average 2 years. We map out the current situation from a 360° scan:

• What prevents a nurse from starting in a general practice?
• Which GP practices are interested? Where are they in the decision-making process?
• What barriers hold back non-interested people?

Not only challenges at substantive, team and organizational level form the scope. Systemic motives are also included, which we signal to the necessary policy actors.

Good practices and solutions

Starting from the needs detected, we also find out whether ...

• existing good practices can be optimized;
• good practices are more widely disseminated;
• we can work out solutions in co-creation.

All this based on the conviction that the nurse in general practice is an answer to various challenges in primary care.

We werken hierbij co-creatief. Doorheen alle stappen van het onderzoek luisteren we naar de eindgebruikers: de verpleegkundige in de huisartsenpraktijk en de huisartsen. Op deze manier garanderen we dat de gevonden oplossing(en) gewenst, haalbaar en rendabel is. De methodologie van Human Centered Design is onze leidraad. 

First steps research

Meanwhile, the first year of research has come to an end and the second is well underway. The following steps have been taken:

• A quick search of the (inter)national literature;
• Cognitive interviews with various experts, general practitioners and nurses in general practice;
• Non-participating observations of intake interviews for internships in the context of the postgraduate nursing degree in general practice;
• Intervision with general practitioners and nursing students in the general practice upon completion of the internship.

Conclusions 

The following conclusions are drawn from this:

• The need for support from the general practitioner and the general practice is urgent.
• The nurse in the general practice is one of the possible solutions for the support needs of a general practitioner.
• The nurse in the general practice has added value for the patient and the general practitioner.
• The profile of the nurse in general practice and, by extension, the nurse in primary care, needs to be worked out urgently.
• There are many barriers for both GPs and nurses to work together in a GP practice. Some thresholds are parallel, some unique.
• Thresholds at systemic or macro level such as legal and financial restrictions can be removed. The research group is monitoring this, but is not actively investigating.
• Thresholds at team and clinical level can be supplemented with individual behavioral determinants of those involved.
• Nurses in a general practice with a package of tasks limited to administrative support are excluded in this study.

5 research questions

The first year of research led to 5 research questions. These have been submitted to the members of our advisory committee (including VIHPs and general practitioners) and our "Council of the Wise":

1. How can we ensure that the decision to adopt a VIHP is the right one and a sustainable response to the needs of the GP (practice) (HA(P))?
2. During the recruitment procedure, how can we ensure that there is a sustainable match between the VIHP and HA(P) on a personal level and with practice?
3. How can we get the VIHP to make more sustainable choices in the selection / signing / negotiation phase about the (future) employment situation?
4. How can we support starting VIHP and the HA(P) with onboarding (from the first working day to about 6 months)?
5. How can we support those practices where a VIHP has been working for at least 6 months in complementary cooperation?

Onboarding

After a thorough analysis (quantitative and qualitative), the HKW "onboarding" is selected. Onboarding includes the first day of work to approximately 90 days of employment.

9 VIHPs were interviewed to collect user insights (empatize). What does the onboarding process look like in reality? What are possible success factors? What are possible barriers?

On 11/10/2022, a first design sprint continued (define, ideate, prototype). You can read all the details here. A tip of the veil: the HKW demand has narrowed and new ideas have been formulated. All this resulted in two rudimentary project ideas. The project idea of the GPS has been further elaborated by the researchers and submitted to the advisory committee on 28/11/2022. We are currently processing the feedback and working towards a prototype.