Nurse practitioners in primary health care: the Jamaican experience. Part II

ABSTRACT

This discussion of Jamaica's experience with nurse practioners in primary health care (PHC) reviews entry requirements, recruitments, and selection; selected specialist tracks; the curriculum; finance, administration, and management; program implementation; initial evaluation and continuing education; the 2nd class; subsequent intakes; class 4; and performance and problems. Minimum entry requirements include registered general nurse; registered midwife or acceptable substitute post basic course for male nurses; and 5 year post registration practice in a relevant clinical specialty. Major curriculum components include general subjects aimed at broadening skills in communication, social interaction, scientific problem solving, and other such behaviours; related/supporting sciences; nursing subjects; and medical subjects. There is a 6-week core curriculum followed by a 2-stranded specialist curriculum of 18 weeks, consisting of medical topics relevant to each sub-group. This period is followed by 6 months of internship. The nurse practitioner program is a cooperative/collaborative venture between the Ministry of Health and the Faculty of Medicine. The nurse practitioner program was launced in July 1977 with 25 students -- 18 in family nurse practitioner course and 7 in the course for nurse pediatricians. Following graduation of the 1st class, faculty members undertook a complete review and evaluation of the curriculum. Subsequently, some changes were made, including increased pediatric content of the family nurse practitioner course; reorganization of content and hours devoted to research/epidemiology; increased pharmacology input; and modification in the scheme for student evaluation. A 2nd group, consisting of 22 students, began the courses on September 1, 1978. To date, 2 additional groups of students have been admitted to the program. To provide data on nurse practitioners' functioning in PHC settings in Jamaica, the Advanced Nursing Education unit encouraged its students to conduct a series of small research studies into various aspects of the nurse practioner progam. 2 studies were conducted and completed in 1979 and 1 study is now nearing completion. Thus far experience shows that the Jamaican nurse practitioner is well received by selected health care personnel with whom she works, and health care consumers express maximum satisfaction with care received from nurse practioners. Major problems associated with the program are of 2 types those related to education/training; and those affecting the work and service of nurse practitioners. Despite problems, morale among teaching staff and students remains high, and a large majority of nurse paractitioners reported increased job satisfaction in their present role (AU)