Birgitta Ljungbeck

---

Exploring the pioneering nurse practitioner role in Sweden

The nurse practitioner role is undergoing a global evolution to meet the increasing demands of healthcare. The growing population of older adults with chronic illnesses and complex healthcare requirements presents a significant challenge to healthcare resources. These patients require person-centred care with consistent access to healthcare providers, a need that the nurse practitioner role might be equipped to fulfil. Nurse practitioners are seasoned professionals who have pursued additional education, typically at the master’s level. Their specialized expertise in advanced nursing and expanded medical skills enable them to autonomously manage both nursing and medical needs in clinical practice. In Sweden, the advancement of the nurse practitioner role is in its early phases, it lacks national regulation and formal recognition as a professionally protected title. Nonetheless, local initiatives to develop the role have been undertaken, and there is ongoing dialogue at the national level with interest from the Swedish Government in formalizing the role. This aligns with the evolving healthcare reform, and the transition from hospital-based care to home-based care. Consequently, this transition necessitates a heightened level of nursing expertise in municipal healthcare, a demand that could potentially be met by the nurse practitioner role. Nevertheless, the development of the nurse practitioner role is complex and necessitates further research and preparation. Therefore, the overall aim of this thesis is to explore the pioneering Nurse Practitioner role by situating it within the Swedish context, across diverse viewpoints to guide its potential role development into municipal healthcare. The thesis comprises four studies: three qualitative (I, III, IV) and one employing iterative qualitative and quantitative components (II). Study I involves a scoping review, that uses qualitative content analysis to examine 16 papers on content in nurse practitioner education. Study II, uses a Delphi survey approach in corporating three rounds of questionnaires with the aim of establishing consensus on challenges and opportunities for nurse practitioner role development. Content analysis was followed by descriptive statistics in subsequent rounds. Study III, a focus group study, uses thematic analysis to help identify the preparatory work required before introducing the nurse practitioner role into municipal healthcare. The final study (IV) is centred on Swedish nurse practitioners’ experiences working in this pioneering nursing role. The data collection for the fourth study involved 15 semi-structured individual interviews, which were examined using content analysis. The findings from these studies offer insights into the nurse practitioner role in a Swedish context across diverse viewpoints to guide potential role development in municipal healthcare. Study I presents the core content of nurse practitioner education, while Study II identifies challenges and opportunities. Study III deals with the preparatory work needed before role development and encompasses areas such as education, national and local regulation, and strategies to foster acceptance for the nurse practitioner role within the healthcare team. The findings from Study IV provide insights into the reality of working as a nurse practitioner in Sweden, providing crucial perspectives to consider in on-going role development. The thesis as a whole offers insights that can be of value in the preparatory phase for developing the nurse practitioner role. There must be a clear and compelling intention to enhance patient satisfaction when developing the NP role. For it to be accepted as a new professional nursing role, national guidelines are required to bolster local role development in healthcare teams.