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Keywords:

  • acute care;
  • Bales;
  • communication;
  • decision-making;
  • healthcare team;
  • interaction process analysis;
  • nurse practitioner

Aims and objectives:  This paper aims to describe communication and decision-making in healthcare teams following the introduction of an acute care nurse practitioner role.

Background:  Healthcare teams need to establish clear processes for communication and decision-making about patient care to be effective. Little is known about how acute care nurse practitioners affect these team processes.

Design:  Observational/descriptive study.

Methods:  Structured non-participant observations of acute care nurse practitioners and healthcare team members during routine patient care activities were completed to identify the verbal and non-verbal behaviours. Data were collected in two hospitals in one Canadian province from March–May 2009 for a total of 17 hours and 23 minutes. Descriptive statistics were generated.

Results:  Differences in communication and decision-making were noted between the cases. The acute care nurse practitioners in Case 1 spoke most frequently with physicians when making patient care decisions while the acute care nurse practitioners in Case 2 spoke most frequently with the nurses. The acute care nurse practitioners needed to validate all patient care decisions if prescriptive authority had not been transferred to them.

Discussion:  Much of the potential of acute care nurse practitioner roles rests on the ability to enact the full scope of their role. Acute care nurse practitioner scope of practice depends on the legislation, the transfer of decision-making authority in the organisation, and the messages received form the medical and nursing leadership group.

Conclusions:  This appears to be the first in-depth description of communication and decision-making in healthcare teams following the introduction of acute care nurse practitioners and furthers our understanding of how system-level imperatives filter down to healthcare teams.

Relevance to clinical practice:  The transfer of prescriptive authority to acute care nurse practitioners affected communication and decision-making and changed the way routine activities were conducted.