When Bothering is Part of Professional Practice: Interprofessional Collaboration and Institutional Influences in Primary Care

ABSTRACT

In Western healthcare systems, increasing numbers of nurse practitioners are practicing in primary care organizations, and their integration onto interprofessional teams can be somewhat bumpy. In this article, we rely on the institutional theory of organizational communication to investigate the situated communication challenges faced by NPs as they integrate onto primary health care teams (RQ1), and how these local challenges manifested institutional features (RQ2). We analyze interview data from NPs, their physician partners, clinical nurses, and a network administrator for NPs at five family medicine clinics in Quebec, Canada. We found three main challenges to IP communication between NPs and physicians, namely a lack of time, the professional necessity of bothering, and talking to – and like – a doctor. We present the solutions that participants found to overcome or workaround these challenges. We also interpreted the institutional features that inflected – or “moored” – the situated communication practices and challenges reported by our participants to better understand how the local experience of IP communication is shaped by broader institutional forces.

Acknowledgment

We would like to thank Editor Theresa Thompson and two anonymous reviewers who generously engaged with our work, making helpful suggestions for needed improvements. We would also like to thank Kirstie McAllum, Mirjam Gollmitzer, and Mélanie Chaplier who commented on an earlier version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. A nurse clinician (infirmière clinicienne) has a different professional scope of practice than an NP, typically with less autonomy. They usually do not hold a master’s degree as do NPs.

2. This is part of an electronic communication system by which many professionals communicate. A “task” is similar to an e-mail but appears as a request for the other to take action.

Additional information

Funding

This researched was funded by a dual grant by the Quebec Network on Nursing Intervention Research and by Réseau-1 Québec (Reseau de connaissances en services et soins de santé intégrés de première linge), from their Spring 2018 competition.