Full practice authority for Dutch PAs and NPs

This survey evaluated the effects of granting legal full practice authority (FPA) to NPs and PAs in the Netherlands. The performance of specified reserved medical procedures and legal cross-compliance requirements was probed. Interviews focused on competence, knowledge, skills, responsibilities, routine behavior, NP or PA role, acceptance, organizational structure, collaboration, consultation, and adherence with protocols and resources. Data collection took place between 2011 and 2015. Quantitative data included 1,251 NPs, 798 PAs, and 504 physicians. Interviews were held with 33 healthcare providers and 28 key stakeholders, and 5 focus groups (31 health-care providers). After obtaining FPA, the proportion of NPs and PAs performing reserved procedures increased from 77% to 85% and from 86% to 93%, respectively; the pro portion of procedures performed on own authority increased from 63% to 76% for NPs and from 67% to 71% for PAs. The mean number of monthly contacts between NPs and PAs and physicians about procedures decreased (from 81 to 49 and from 107 to 54, respectively), as did the mean duration in minutes (from 9.9 to 8.6 and from 8.8 to 7.4, respectively). Use of FPA depended on the setting, as physician and medical board skepticism hampered full implementation. Legal cross-compliance requirements were mostly fulfilled. Informal practice was legalized. NPs and PAs had many opportunities to independently prescribe and to perform catheterizations, injections, punctures, and small surgical procedures. Care processes were organized more efficiently, and the most appropriate healthcare provider performed the required services. This led to the recommendation to continue FPA.(1)