title: Complex patients and interprofessional relationships: Perceptions of primary care nurse practitioners and primary care physicians.
abstract: OBJECTIVE
  The literature describing primary care nurse practitioners (PCNPs) and primary care physicians (PCPs) suggests that PCNPs provide care to patients with less complicated diagnoses than their PCP colleagues. However, other literature suggests the contrary. Therefore, the purpose of this qualitative study was to understand how patients are assigned and cared for by primary care clinicians and how these clinicians relate to one another. Additionally we explore how PCNPs relate to physicians outside the practice.
  
  
  METHODS
  Two nurse investigators conducted in-depth qualitative interviews with a nurse practitioner and a family medicine physician leader in each of 10 primary care practices. A content analysis was used to identify major themes.
  
  
  CONCLUSIONS
  The participating PCNPs and PCPs have highly collaborative relationships. PCNPs often function independently, engage in reciprocal consultations with PCPs, and provide care to highly complex patients. In contrast to their relationships with practice colleagues, PCNP relationships with physicians outside the practice are disruptive.
  
  
  CONCLUSIONS
  These findings indicate that PCNPs are well positioned to assume responsibility for a diversity of primary care patients, including those with complex diagnoses. To promote the more effective integration of PCNPs, interprofessional barriers must be addressed by healthcare organizations and policy experts.
authors.affiliation: Department of Nursing, College of Staten Island, City University of New York, Staten Island, New York.|Graduate Center, City University of New York, New York, New York.
authors.forename: Barbara
authors.initials: B
authors.lastname: DiCicco-Bloom
authors.affiliation: University of Pennsylvania Health System, Philadelphia, Pennsylvania.|University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.
authors.forename: Regina S
authors.initials: RS
authors.lastname: Cunningham
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D009369:Neoplasms / Q000451:nursing / Q000628:therapy*; D009518:New York; D009722:Nurse Practitioners; D010414:Pennsylvania; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care
keywords: Primary care; interprofessional relationships; nurse practitioners; qualitative analysis