The following is a summary of “Factors Influencing Nurse Practitioner Panel Size in Team-based Primary Care: A Qualitative Case Study,” published in the August 2024 issue of Primary Care by Martin-Misener et al.
The global public health crisis stemming from inadequate access to healthcare has intensified the reliance on nurse practitioners (NPs) in primary care, driving interest in understanding the factors that influence their patient panel capacity. This study sought to explore the determinants of nurse practitioner-patient panel size within team-based primary care settings in Ontario, Canada. Utilizing a multiple case study design, eight diverse primary care practices, including both rural and urban environments, were purposively selected. Each case comprised at least two nurse practitioners with a minimum of two years experience in primary care. Data collection involved in-depth, in-person interviews with 40 participants, including 19 nurse practitioners, 16 administrators (executives, managers, and receptionists), and 5 physicians. Interviews were audio-recorded, transcribed, and subjected to content analysis.
The findings revealed that nurse practitioner-patient panel size is influenced by a complex interplay of patient, provider, organizational, and system-level factors, which were further categorized into eight sub-factors: the complexity of patients’ health and social needs, the holistic nursing model of care, the experience and confidence of the nurse practitioner, the composition and functionality of the multidisciplinary team, the availability of clerical and administrative support, and the specific activities and expectations placed on nurse practitioners. Despite these influences, all participants acknowledged the difficulty in defining nurse practitioner panel size, describing it as “a grey area.” The study highlighted that the foundation of nurse practitioners’ care delivery lies in establishing and maintaining longitudinal, holistic relationships with patients, necessitating addressing a wide range of needs during each visit. Social determinants such as gender, poverty, mental health issues, historical trauma, marginalization, and literacy further complicate the patient’s needs, thereby impacting the NPs’ capacity to manage larger patient panels.
Participants noted that NPs often strive to address patients’ concerns during each visit, which inherently limits their panel size. The study concludes that while nurse practitioners’ holistic approach, which includes attention to social determinants of health alongside acute and chronic conditions, is integral to patient care, it also constrains their panel size. To optimize care delivery and potentially expand NP panel capacity, multidisciplinary teams must strategically structure their services to meet patients’ comprehensive health and social needs more effectively.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02547-6
