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1 Collaborative Practice by Nurse Practitioners and Physicians in Long-Term Care Facilities: A Mixed-Methods Study Faith Donald and Alba DiCenso McMaster University Nurse Practitioner Survey Collaboration with the Physician in Long-Term Care March 2006 Throughout this survey, we are using the terms Nurse Practitioner and NP for those nurses who have obtained their extended class (EC) certificate (certification by the College of Nurses of Ontario to function as an NP). The term MD refers to physicians who are general practitioners or family physicians.

2 Part A Demographics and Experience 1a. What is your educational background? (Check ALL that apply) Nursing Diploma BScN Non-nursing Baccalaureate (please specify) Master of Nursing Non-nursing Masters Degree (please specify) PhD (please specify) 1b. How did you obtain your Nurse Practitioner education? (Check ALL that apply) COUPN certificate program Non-COUPN certificate program COUPN integrated BScN/NPprogram Non-COUPN degree program COUPN transition program Acute Care NP Program Other (please specify) 1c. How did you become licensed as an RN (EC)? (Check ALL that apply) Completed COUPN program Wrote CNO registration exam Completed Non-COUPN program Completed the CNO three step process (Portfolio, OSCE, registration exam) Other (please specify) 2. What is your age in years? years 3a. In total, how long have you practiced as a registered nurse [including as an RN(EC)]? 3b. How many years did you practice as an RN in longterm care (LTC), prior to becoming an RN(EC)? 3c. In total, how many months have you practiced as an RN(EC)? 3d. How many months have you worked in LTC as an RN(EC)? 3e. How many months have you worked in this LTC setting as an RN(EC)? 3f. Have you worked in this LTC setting in another capacity (e.g., RN) prior to your NP role? years months years as an RN in LTC months months months Yes No

3 4a. Are you currently practicing Full-time 4b. Please describe your work experience since becoming an NP, other than your current long-term care position? (e.g., 13 months in a CHC, 22 months in a regional geriatric program, etc.) Casual Part-time Contract (specify length of contract) years 5a. Would you classify your work location as Remote Rural Urban 5b. In what area of Ontario is your work setting located? Northern Southern Central 5c. Within how many long-term care facilities do you currently work? 5d. How many GPs or family MDs do you work with on a frequent basis, taking into consideration all the LTC facilities in which you work? 6. What percentage of your time is spent in each activity? Long-term care facilities MDs % Clinical in long-term care % Clinical outside of LTC % Management/leadership in long-term care % Research % Education/Training provision % Professional development % Other (please specify) 7a. Have you had previous experience with MD-NP collaboration? Yes, proceed to 7b No, proceed to Part B 7b. If yes, please describe the type of practice setting and duration of the MD-NP collaboration immediately prior to your current MD-NP collaboration. 7c. Practice setting(s) for previous collaboration (e.g., community health centre, nursing home): 7d. Duration of previous collaboration: months 7e. How satisfied were you with the past collaborative relationship with the MD? Not Extremely (please circle one number) satisfied satisfied

4 Part B Collaborative Experience with the LTC Physician Please complete the following information for each long-term care facility in which you work. 1a. Name of long-term care facility: 1b. Number of beds: 1c. Type of facility: Nursing Home Home-for-the-aged Other: 2. Were you involved in developing the proposal for your NP position in this LTC facility? Yes No 3. How many hours per month do you work at this facility? 4. Please identify the one physician (GP or Family Physician) with whom you work most frequently at this facility. 5. How long have you worked with this MD at this facility? hours MD s Name: months 6. How would you describe the extent of collaboration with this MD? (please circle one number) 7. How satisfied are you with the collaborative relationship with this MD? (please circle one number) No Total collaboration collaboration Not Extremely satisfied satisfied 8. How much time per month is currently spent collaborating with this MD on specific resident issues? 9. Please briefly describe the collaborative structure (i.e., how collaboration occurs) at this facility. hours

5 10. Please describe the ways you communicate/interact with this MD in your practice setting (check ALL that apply). Discussions on the telephone Unplanned communication (e.g. meeting in the hallway) As needed e.g. we seek each other out when there are questions about a resident Regular meetings Work side by side with the MD Review charts/orders Written messages (not in the residents charts) Messages via staff Other (please describe) 11. List the three most important contributions that you make, as an NP, to resident and/or family care at this facility

6 PART B1: MEASURE OF CURRENT COLLABORATION Consider your current experience of collaborative practice between you and the physician you have named above and rate your level of agreement or disagreement with each statement. Please check the one best answer for each statement below The general practitioner or Family physician and you: 1. Plan together to make decisions about the care for the residents 2. Communicate openly as decisions are made about resident care 3. Share responsibility for decisions made about resident care 4. Co-operate in making decisions about resident care 5. Consider both nursing and medical concerns in making decisions about resident care 6. Co-ordinate implementation of a shared plan for resident care 7. Demonstrate trust in the other s decision making ability in making shared decisions about resident care 8. Respect the other s knowledge and skills in making shared decisions about resident care 1 Disagree 2 Disagree 3 Disagree 4 Agree 5 Agree 6 Agree 9. Fully collaborate in making shared decisions about resident care [Copyright 2001 by Jones, Way and Associates. All rights reserved. Used with permission from Jones, Way and Associates (Way, Jones, & Baskerville, 2001). Adapted using resident instead of patient and slightly disagree and slightly agree instead of neutral and not applicable by Faith Donald] PART B2: PROVIDER SATISFACTION IN CURRENT COLLABORATION Consider your current experience of collaboration with the physician you have named above and rate your current level of satisfaction or dissatisfaction with each statement. Please check the one best answer for each statement below What is your current level of satisfaction with: 1. The shared planning that occurs between you and the physician while making decisions about resident care 2. The open communication between you and the physician that takes place as decisions are made about resident care 3. The shared responsibility for decisions made between you and the physician about resident care Satisfied 5 Satisfied 6 Satisfied

7 Please check the one best answer for each statement below What is your current level of satisfaction with: 4. The cooperation between you and the physician in making decisions about resident care 5. The consideration of both nursing and medical concerns as decisions are made about resident care 6. The coordination between you and the physician when implementing a shared plan for resident care 7. The trust shown by you and the physician in one another s decision making ability in making shared decisions about resident care 8. The respect shown by you and the physician in one another s knowledge and skills 9. The amount of collaboration between you and the physician that occurs in making decisions about resident care 10. The way that decisions are made between you and the physician about resident care (that is, with the decision making process, not necessarily with the decisions) 11. The decisions that are made between you and the physician about resident care 12. The amount of time you spend consulting with the physician Satisfied 5 6 Satisfied Satisfied 13. The availability of the physician 14. The appropriateness of consultations initiated by the physician 15. The quality of care provided by the physician [Copyright 2001 by Jones, Way and Associates. All rights reserved. Used with permission from Jones, Way and Associates (Way, Jones, & Baskerville, 2001). Adapted using resident instead of patient and slightly disagree and slightly agree instead of neutral and not applicable ; added questions 12-15, by Faith Donald and Alba DiCenso.] Thank you for taking the time to complete this survey. Please return it in the enclosed self-addressed, stamped envelope or fax to Faith Donald at (905) by June 15, 2006, or as soon thereafter as possible.

8 References Way, D., Jones, L., & Baskerville, N. B. (2001a). Improving the effectiveness of primary health care delivery through nurse practitioner/family physician structured collaborative practice. Joint University of Ottawa Department of Family Medicine and School of Nursing project funded by Health Canada's Health Transition Fund. Ottawa, ON: University of Ottawa. Way, D., Jones, L., & Baskerville, N. B. (2001b). Improving the effectiveness of primary health care delivery through nurse practitioner/family physician structured collaborative practice. Joint University of Ottawa Department of Family Medicine and School of Nursing project funded by Health Canada's Health Transition Fund. Ottawa, ON: University of Ottawa.