What Do Faculty Physicians Know About Nurse Practitioner Practice?

Dynamics of Physicians' Trust in Fellow Health Care Providers and the Role of Health Information Technology

Physicians are expected and incentivized to coordinate patient care with other providers, including nonphysician clinician (NPC) members of care teams, requiring trust. Trust in the context of care teams has not been well-studied; even less is known about how health information technologies (HIT) may modify trust in these relationships. We conducted semistructured interviews with 30 physicians at a Midwestern academic center to examine how physicians determine they can trust NPCs, and how technology modifies these relationships. A majority of physicians base trust in NPCs on cognitive factors such as competence and reliability. Technology enhances trust between physicians and NPCs by supporting evidence-based decision making; it can also erode trust by limiting opportunities for developing familiarity and comfort with fellow providers. Our work has implications for enhancing HIT to promote trust between providers, and for developing more robust measures of trust that can be used in evaluating and improving teamwork within practices.

Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention

The Institute of Medicine's The Future of Nursing report recommended the extension of nurse practitioner (NP) fellowship programs to highlight and assess competencies after completion of licensure. The initiative, "Participation in a nurse practitioner fellowship to instill greater confidence, job satisfaction, and increased job retention as nurse practitioners promptly transition from novice to expert clinician," evaluated NP satisfaction between NPs who had not completed a fellowship versus NPs who had participated in a fellowship. Transition of an NP was evaluated through the Misener Nurse Practitioner Job Satisfaction Scale via 258 NPs through Emory Healthcare, MD Anderson, DNP discussion groups, and Show Me Your Stethoscope from social media. A series of independent t-tests were performed to determine statistical significance. The results of the analyses found that individuals who had participated in an NP fellowship had significantly higher scores on a sense of value for "what you do," monetary bonuses, and compensation for services outside of normal duties and obtained statistical significance. Owing to the positive trends of the surveys, continuation of NP fellowships is recommended for a successful NP role transition to develop clinical growth, retention, leadership skills, and ultimately an expert clinician.

Attitudes towards interprofessional collaboration of Primary Care teams participating in the 'More Doctors' (Mais Médicos) program

OBJECTIVES

to compare the attitudes regarding interprofessional collaboration of health professionals that make up the Family Health Strategy teams participating in the 'More Doctors' (Mais Médicos) program; and to identify factors associated with attitudes of interprofessional collaboration.

METHOD

a descriptive, transversal and comparative study developed with 63 health professionals who responded to the Jefferson Scale of Attitudes Toward Interprofessional Collaboration. The data were statistically analyzed.

RESULTS

the sum of the scale items ranged from 88 to 139 points. The analysis of all the Family Health teams indicated statistically significant differences between the scores of the scale and the professional category and between the scores and the education level, suggesting that nurses and professionals with higher education are more inclined towards collaborative practice. The analysis according to the profile of the doctor - Brazilian, Cuban or foreign exchange doctor - found no statistical differences regarding the physicians' scores, nor in the scores of the components of teams with different profiles.

CONCLUSION

the profile did not suggest a statistically significant greater or lesser inclination of the doctors or teams toward interprofessional work. This study can support new studies which will contribute to the analysis of inter-professional collaboration and the impact of the Mais Médicos program.

Measuring physicians' trust: A scoping review with implications for public policy

Increasingly, physicians are expected to work in productive, trusting relationships with other health system stakeholders to improve patient and system outcomes. A better understanding of physicians' trust is greatly needed. This study assesses the state of the literature on physicians' trust in patients, other health care providers, institutions, and data systems or technology, and identifies key themes, dimensions of trust considered, quantitative measures used, and opportunities for further development via a scoping review. Peer-reviewed, English-language research articles were identified for inclusion in this study based on systematic searches of the Ovid/Medline, Pubmed, Proquest, Scopus, Elsevier, and Web of Science databases. Search terms included "trust" along with "physician," "doctor," "primary care provider," "family practitioner," "family practice," "generalist," "general practitioner," "general practice," "internist," "internal medicine," or "health professional," and plausible variants. Among the relevant articles identified (n = 446), the vast majority focused on patient trust in physicians (81.2%). Among articles examining physicians' trust, rigorous investigations of trust are rare, narrowly focused, and imprecise in their discussion of trust. Robust investigations of the effects of trust or distrust-as opposed to trust's determinants-and studies using validated quantitative trust measures are particularly rare. Studies typically measured trust using the language of confidence, effective communication, or cooperation, rarely or never capturing other important dimensions of trust, such as fidelity, the trustee's reputation, social capital, vulnerability, and acceptance. Research employing new, validated measures of physicians' trust, especially trust in institutions, may be highly informative to health system leaders and policymakers seeking to hone and enhance tools for improving the effectiveness and efficiency of the health care system.