In response to: Williams A. & Jones M. (2006) Patient's assessments of consulting a nurse practitioner: the time factor. Journal of Advanced Nursing53(2), 188–195.


In their article on ‘Patient's assessments of consulting a nurse practitioner: the time factor’, Williams and Jones (2006) state that ‘patients’ perceptions are important, not only because they are a barometer of the appropriateness and effectiveness of services, but because they are a source of unique knowledge about the way in which people use services’ (p. 189). It certainly is true that patients have knowledge regarding their reasons for using or not using Nurse Practitioners (NPs). Why then is there so little research aimed at detecting public perceptions of the nurse practitioner as a primary caregiver? At a time when the healthcare industry is changing rapidly, and with ever-increasing demands for healthcare reform and cost reduction, the role of the NP can make a significant contribution to healthcare advancements and economies. It could be argued, however, that a barrier to this is the apparent reluctance of the nursing community to conduct research into consumer awareness and to market itself effectively. Insufficient public recognition and understanding of the role of nurse practitioners could prove to be detrimental to the progress of the NP (Armer 1997).

Marketing literature is replete with cautions that there must be a need or desire for the product or service being offered, and that the brand (NPs in this case) must be able to demonstrate how it can meet that need (Dominiak 2004). The need for high quality and cost-effective healthcare is well recognised and is now a major focus of policy makers in the United States (Badger & Behler 2003) as it is elsewhere in the world. It is necessary, therefore, for NPs to demonstrate how they are capable of meeting the need to instill the desire for NP services among consumers. There has been a multitude of studies over the past 20 years which support the ability of the NP to treat patients successfully on a par with, and sometimes better than, medical doctors (Horrocks et al. 2002, Badger & Behler 2003, Lenz et al. 2003, Mundinger et al. 2000); and sometimes to do so at a lower cost (Dahle et al. 1998). Educating the public about these findings is a key to the success of the NP in primary care.

According to the Chartered Institute of Marketing, the largest marketing body globally, two important aspects of marketing are the recruitment of new customers and the retention of existing customers (Wikipedia 2006, p. 1). NPs must start with the recruitment of new customers. In order to do so, research is needed to first determine the public's knowledge regarding the existence of NPs, and second to understand their perceptions of NPs, so that effective marketing campaigns can be launched. As Buppert (2004) states, ‘it is time for NPs to state, publicly and consistently, that ‘‘NPs are experts in primary care’’, and not only that ‘‘NPs do primary care in a collaborative relationship with a physician'’’ (p. 426). Educating the public about the fact that NPs are highly capable in primary care situations is a beginning step in the creation of a market-led demand for NPs.

In 2002, 67% of NPs practising in the United States were doing so in primary care settings (American Academy of Nurse Practitioners 2003). When polled by the American Academy of Nurse Practitioners (2003), 41% of NPs in the U.S. reported that lack of recognition as primary care providers was the number one barrier encountered in their practice. It is my hope that, in future, there will be more research undertaken in order to determine where NPs stand with the general public. Samples for such research should not only include patients who have used NP services in the past, but also those who as yet have had little or no contact with NPs. Such research would provide a foundation on which to base appropriate marketing strategies in order to better inform the public about the role and qualifications of NPs in primary care.