Factors Enabling Advanced Practice Nursing Role Integration in Canada

Lack of effective leadership to advocate change, set priorities or manage the implementation process, and changes in leadership, were presented as barriers.

“Conversely, lack of effective leadership to advocate change, set priorities or manage the implementation process; and changes in leadership were presented as barriers [55, 67–69].”

Competencies, e.g. adequate training and good computer experience/skills, facilitated implementation.

“competencies, e.g. adequate training and good computer experience/skills were shown to facilitate implementation [16, 17, 31, 32, 34, 41, 42, 44, 54–58, 60, 67, 70, 77, 80, 81, 84–86].”

Interventions that demonstrated clear and consistent clinical evidence of benefit or good applicability relevant to setting were shown to facilitate implementation.

“interventions that demonstrated clear and consistent clinical evidence of benefit [3, 16, 34, 35, 51, 55, 56, 68, 74, 89] or good applicability relevant to setting [3, 35, 68] were shown to facilitate implementation.”

The presence of supportive national and local policies which were mandatory and appropriate legislative mechanisms often acted as potent activators and promoted implementation of clinical guidelines, telemedicine and new roles (e.g. nurse practitioners).

“The presence of supportive national and local policies which were mandatory and appropriate legislative mechanisms often acted as potent activators [51] and promoted implementation of clinical guidelines, telemedicine and new roles (e.g. nurse practitioners) [34, 52–56].”

Public awareness could result in pressure to introduce a new intervention, and this was presented as a facilitator for motivating the uptake of telemedicine and for educating the public about new nurse practitioner roles.

“Finally, public awareness could result in pressure to introduce a new intervention. This was presented as a facilitator for motivating the uptake of telemedicine and for educating the public about new nurse practitioner roles [34, 55].”

A team-based partnership approach, collaborative efforts and good coordination between stakeholders and organisations were important for implementation.

“A team-based partnership approach, collaborative efforts and good coordination between stakeholders and organisations were all shown to be important for implementation [34, 41, 55, 77].”

Concerns about reduced autonomy or trust, independence of practice or inability to practise to full scope impeded implementation.

“Concerns about reduced autonomy or trust, independence of practice or inability to practise to full scope were all shown to impede implementation [16, 31, 35, 39, 54, 55].”

Economics and financing, including the economic climate, the ways in which the government allocated funding, and investment decisions made by local health authorities, were shown to affect implementation of guidelines and new roles.

“Economics and financing including the economic climate, the ways in which the government allocated funding, and investment decisions made by local health authorities were shown to affect implementation of guidelines [66] and new roles [54, 55].”

Positive and trusting inter-professional relationships through bi-directional communication and opportunity to discuss salient matters were perceived as facilitators.

“Positive and trusting inter-professional relationships through the presence of bi-directional communication and giving staff abundant opportunity to discuss salient matters and provide input to challenges before and during implementation were perceived to be facilitators [32, 41, 55].”