This study outlined the current situation of GPNs in China. Although the sample size was small and limited to one city, it provides valuable information. With the emphasis on primary healthcare and general practitioners, GPNs play a key role in providing a continuum of care for patients and improving their health [18]. GPNs are registered nurses who work autonomously within multidisciplinary general practice teams in primary healthcare and are usually employed by general practitioners. Unlike other countries, several tertiary general hospitals in China have established General Practice Outpatients Departments that mainly provide whole-person, continuous, and holistic management for patients with chronic and multi-morbidities [19]. However, the current roles of GPNs are diverse, their tasks are limited, and the scope of their functions is not clear [8].
Through the investigation of 14 GPNs in Beijing, this study found that there is currently a lack of full-time GPNs in China. Their roles are restricted to routine nursing and outpatient tasks, such as triage, calling, guiding, and maintaining order, which do not utilise the expertise of general practice nursing. This further illustrates the current situation that there are no dedicated full-time general practice nurse positions in China. However, European countries and the US have full-time GPNs who play an important role in primary care and General Practice. Globally, GPNs have the potential to earn a substantial income through their practice [9]. The UK has three types of GPNs based on their duties.
Medical institutions often prefer to hire experienced GPNs over training new general practitioners, as this saves time and resources for pre-employment training [20, 21]. After standardised training, GPNs can provide comprehensive and continuous health management services for patients with chronic diseases in remission, as well as personalised care for various populations, thereby significantly relieving the clinical practice pressure on general practitioners [22,23,24]. In the US, GPNs provide tailored services to various patients, extending to school, home occupational, and mental healthcare. Additionally, Japan has home-visit nurses who provide home medical care services [8].
Meanwhile, this study found that the work content of GPNs was limited, with inadequate functions and a lack of professionalism. Interviewees reported a lack of standardised workflows for GPNs in their hospitals. This further illustrates that the extensive job content and unclear division of responsibilities for GPNs have significantly impacted the quality of general medical services, which has become an urgent problem in China [25]. GPNs play a crucial role in health management and education for patients and community residents. In medical teams, GPNs collaborate closely with other professionals such as doctors, pharmacists, and rehabilitation therapists to provide high-quality medical services, improve medical efficiency and quality, and ensure that patients receive comprehensive and integrated treatment. Additionally, long-term health management and follow-up for patients with chronic diseases are also required to ensure treatment effectiveness and condition stability. Clarifying the role of GPNs can promote collaboration between doctors and nurses and ensure that GPNs contribute fully to medical practice. This is essential for optimising the role of GPNs in medical teams and strengthening their professional identity [26,27,28,29].
With the continuous development and improvement of the medical system, clarifying the competencies of GPNs is crucial for ensuring the quality of medical services and advancing medical care. Systematic, standardised training can enhance nursing services by providing nurses with knowledge of basic theory, clinical nursing skills, and the ability to independently deliver high-quality care in a standardised manner. However, the GPN participants in this study did not receive standardised GPN training. Previous studies have shown that GPNs’ lack of knowledge about General Practice can directly affect the quality of general practice nursing [6, 25]. Training and education for GPNs are vital for the efficient and high-quality operation of general practice medical teams. Hou et al. [30] suggested that GPNs should collaborate with general practitioners to treat and manage common and chronic diseases and achieve health management for high-risk groups. The competence of GPNs is crucial for the positive representation of their roles and responsibilities, and is a key aspect of nursing development [31]. Despite the multifaceted competency requirements for GPNs, there are currently no uniform training standards, which does not meet the growing health needs of the population [32]. Through our investigation, we found a lack of systematic training for GPNs in General Practice, leading to inadequate comprehension of General Practice and unclear perceptions of their roles, job responsibilities, and required nursing skills.
Compared to European and North American countries, the competence level of GPNs in China is unclear [33]. GPNs have extensive clinical experience that could significantly improve primary care. To advance their practice, educational opportunities must be provided to upskill existing GPNs. The public also requires a better understanding of this role and its potential contribution to General Practice [31, 34, 35]. Additionally, a substantial gap exists in education levels. In the UK, all new nurses entering General Practice receive pre-occupational training and mentoring, and are provided with opportunities for further education, promotion, and academic support for personal career development [9].
In contrast, nursing school education in China lacks a systematic curriculum for GPNs. Many institutions offer GPN training as an elective course, which does not meet the current requirements of GPN training in China. With the increasing burden of chronic diseases, many countries have reformed their prescribing authority to improve the quality of general practice services. With the gradual improvement of nursing staff qualifications, 13 European countries have enacted laws on nurse prescribing (Table 1) [36,37,38,39,40].
The competence of GPNs is rich and diversified, encompassing knowledge, skills, attitudes, and behaviours. In the future, China should continuously improve GPN competencies through various channels to meet increasingly growing health needs and foster a harmonious medical environment.
Training GPNs requires time. Nevertheless, GPNs are an important force in China’s healthcare system, and strengthening their training is imperative [8]. Government support and the gradual improvement of relevant policies are necessary. Additionally, a systematic nursing school curriculum for GPNs should be established, along with an objective assessment system and evaluation criteria [41]. Furthermore, as primary care institutions are the main practice sites for general practitioners, some scholars have proposed creating a standardised teaching model for GPNs after graduation and cultivating efficient, qualified professionals to provide effective health services to community residents [7]. Therefore, in response to the unbalanced allocation of human resources and increasing health needs in China, GPN training should be strengthened to enhance their competence.
This study demonstrated that the surveyed GPDs lacked full-time GPNs, and active nurses had not received systematic training as GPNs. Additionally, participants reported that most General Practice Outpatient Departments did not have separate treatment areas, and the division of responsibilities among outpatient nurses was unclear. Consequently, nurses could not provide patients with general practice care. Furthermore, nurses’ responsibilities were not clearly defined, preventing them from fully assuming the responsibilities of GPNs. Moreover, most GPNs were older and came from various specialties. These results suggest that the current situation of general nursing practice in China is unfavourable, reflecting the developmental stage of General Practice.
Limitations of the study
This study had several limitations. First, it focused only on Beijing, the capital of China, which has limited representativeness. Although we attempted to expand the sample to GPNs in other regions, we encountered challenges. Second, it did not examine patients, therefore it was unclear if professional GPNs can improve patients’ medical experience and enhance medical services. This is insufficient in demonstrating the importance and necessity of professional GPNs.
Based on these shortcomings, future studies should conduct research in other regions to gain a more comprehensive understanding of the practice of GPNs in different areas of China. In addition, patients should be surveyed to understand their cognition of the current situation of general practice nursing services, and to further emphasise the importance of the role of GPNs.
Add Comment