What is the impact of advanced primary care nursing roles on patients, nurses and their colleagues? A literature review
Abstract
Objectives To review and draw together the existing research evidence to assess the impact of advanced primary care nursing roles, particularly first contact nursing roles, for patients, nurses themselves and their colleagues in order to highlight salient issues for policy, practice and research.Background Internationally, nurses' roles continue to expand in response to doctor shortages and policy drives to provide effective and efficient health services. A body of research exists from which to evaluate the impact of advanced nursing roles on various dimensions of healthcare delivery and organisation.Design and data sources Medline, CINAHL, Applied Social Sciences Index and Abstracts, British Nursing Index, Cochrane Library, EMBASE, National Research Register, and PsycINFO databases were searched, including relevant websites. Studies were included if published in English and relevant to the primary/community care setting. Of a total of 211 papers identified, 88 were of relevance and included in the review.Results Nurses working in many advanced primary care roles such as acute/minor illness, minor injury and long-term conditions provide safe and effective care, and patient satisfaction is generally high. Many factors influence patient satisfaction with, and access to, such services but are little understood. Evidence on cost-effectiveness, efficiency and impact on other health care professionals is inconclusive though research suggests the introduction of extended roles can create uncertainty and intra-/inter-professional tensions.Conclusions Evidence is of variable quality, often ignoring potentially important effect mediators such as the experience and educational level of advanced nurses, the effect of service 'maturation', organisational characteristics and differing patient preferences. The complex range of factors that influence patient satisfaction, access and outcomes of care need further investigation. Recent UK developments in nurse prescribing and the introduction of a national post-registration competency framework may improve working relations and patient understanding and experience of advanced nursing roles in primary care.
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Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.
“Many studies with strong research designs have shown nursing-intensive primary care models to be safe and effective.8,11,18-26”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [18]
Measurable clinical outcomes are systematically found to be equivalent to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.
“Measurable clinical outcomes are systematically found to be equivalent11,18,19,23,27-32 to those produced by medical models, though patient satisfaction tends to be higher for nurse-provided services.11,19,21,26,27,29,30,33,34”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [18]
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- Authors
- Bonsall, K., & Cheater, F. M.
- Affiliations
- University of Leeds (GB)
- Corresponding author
- Bonsall, Kate
- ORCID
- Cheater, Francine M.
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2008-07
- Volume
- 45
- Issue
- 7
- Pages
- 1090-1102
- ISSN
- 0020-7489 (ISSN-L)
- OpenAlex
- W1996153035
- Cited by
- 145
- References
- 88
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 11 · 2022: 4 · 2021: 3 · 2020: 39 · 2019: 4 · 2018: 17 · 2017: 5 · 2016: 4 · 2015: 5 · 2014: 6 · 2013: 10 · 2012: 10
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline (acceptedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Nursing › Issues, ethics and legal aspects › Nursing Education, Practice, and Leadership
- Keywords
- patient satisfaction, health care access, interprofessional relations, cost-effectiveness, nurse prescribing, chronic disease, community-based care
- MeSH terms
- United Kingdom, Nursing, Patients, Primary Health Care, Nurse's Role
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