Shortages of skills needed to deliver optimal health care in rural and remote locations raises questions about using extended scopes of practice or advanced practice models in a range of health professions. The nurse practitioner (NP) model was introduced to address health service gaps; however, its sustainability has been questioned, while other extended scope of practice roles have not progressed in Australia. This study aimed to explore the experiences and perceptions of NPs and their colleagues about barriers to and enablers of extended scope of practice and consider the relevance of the findings to other health professions. Semi-structured, in-depth interviews were conducted with primary, nurse practitioner informants, who were also invited to nominate up to two colleagues, as secondary informants. Data analysis was guided by a multi-level, socio-institutional lens of macro-, meso- and micro-perspectives. Fifteen primary informants and five colleagues were interviewed from various rural and remote locations. There was a fairly even distribution of informants across primary, aged, chronic and emergency or critical care roles. Key barriers and enablers at each level of analysis were identified. At the macro-level were legal, regulatory, and economic barriers and enablers, as well as job availability. The meso-level concerned local health service and community factors, such as attitudes and support from managers and patients. The micro-level relates to day-to-day practice. Role clarity was of considerable importance, along with embedded professional hierarchies and traditional role expectations influencing interactions with individual colleagues. Given a lack of understanding of NP scope of practice, NPs often had to expend effort promoting and advocating for their roles. For communities to benefit from extended scope of practice models of health service delivery, energy needs to be directed towards addressing legislative and regulatory barriers. To be successful, extended scope of practice roles must be promoted with managers and decision-makers, who may have limited understanding of the clinical importance. Support is also important from other members of the interprofessional health care team.

中文翻译：

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影响扩大执业范围的宏观、中观和微观障碍和促成因素的研究：澳大利亚农村护士从业人员的案例

农村和偏远地区缺乏提供最佳医疗保健所需的技能，引发了在一系列卫生专业中使用扩大实践范围或先进实践模式的问题。引入执业护士（NP）模式来解决卫生服务差距；然而，其可持续性受到质疑，而其他扩展的实践角色范围在澳大利亚尚未取得进展。本研究旨在探讨 NP 及其同事对扩大实践范围的障碍和推动因素的经验和看法，并考虑研究结果与其他卫生专业的相关性。对主要的执业护士信息提供者进行了半结构化的深入访谈，他们还被邀请提名最多两名同事作为次要信息提供者。数据分析以宏观、中观和微观视角的多层次、社会制度视角为指导。来自不同农村和偏远地区的 15 名主要知情人和 5 名同事接受了采访。初级、老年、慢性病、急诊或重症监护角色的信息提供者分布相当均匀。确定了每个分析级别的关键障碍和推动因素。宏观层面包括法律、监管和经济障碍和推动因素，以及就业机会。中观层面涉及当地卫生服务和社区因素，例如管理者和患者的态度和支持。微观层面涉及日常实践。角色明确性非常重要，同时嵌入的专业等级制度和传统的角色期望也会影响与个别同事的互动。由于缺乏对 NP 实践范围的了解，NP 常常不得不花费精力来宣传和倡导自己的角色。为了让社区从扩大的卫生服务提供实践模式中受益，需要将精力集中在解决立法和监管障碍上。为了取得成功，必须与管理者和决策者一起推广实践角色的扩大范围，而他们对临床重要性的理解可能有限。跨专业医疗保健团队其他成员的支持也很重要。