Einleitung Die ambulante Grundversorgung in der Schweiz steht vor grossen Herausforderungen. Neue Versorgungsmodelle,
z.B. mit neuen Rollen wie Advanced Practice Nurse (APN), sind nötig. Jedoch ist bisher nicht gut bekannt, in
welchen Arbeitsbereichen APN tätig sind und welchen zeitlichen Aufwand sie für ihre Arbeiten benötigen. Ausserdem stellt
die fehlende Vergütung der APN-Tätigkeiten eine grosse Herausforderung für die Schweizer ambulante Grundversorgung
dar.
Methode Es wurde eine Time-and-Motion-Studie durchgeführt. Insgesamt wurden 12 APN, die in sechs Hausärzt*
innenpraxen der Deutschschweiz tätig sind, über N= 20 Tage beobachtet. Die Zeitdaten wurden statistisch beschreibend
behandelt.
Ergebnisse Insgesamt wurden N= 81 Tätigkeiten in sieben Arbeitsbereichen beobachtet. APN arbeiten über 40% in der
direkten klinischen Praxis und führen dort prioritär Anamnesen und klinische Einschätzungen durch. Doch ein Drittel der
Zeit wird für indirekte Tätigkeiten benötigt, die aber aus der direkten Tätigkeit erwachsen. Insgesamt 26% der beobachteten
Tätigkeiten können heute über die entsprechenden Verordnungen im Schweizer Recht finanziert werden.
Diskussion Direkte klinische Praxis umfasst ein Grossteil der Arbeiten der APN. Die indirekten Tätigkeiten sind eng
mit der direkten klinischen Praxis verbunden und können nicht ausgelagert werden. Entsprechend muss der Bereich der
indirekten Tätigkeiten neu konzipiert werden. Die regulatorischen und rechtlichen Hürden sind substanziell und behindern
den Einsatz von APN in der Schweizer ambulanten Grundversorgung. Eine baldige Regelung ist unabdingbar.
Introduction Primary care in Switzerland is facing major challenges. New care models, e.g., with new roles such as advanced practice nurse (APN), are needed; however, it is not yet well-known in which areas APNs work and how much time they need for their work. In addition, the lack of remuneration for APN activities poses a major challenge for Swiss outpatient primary care. Method A time and motion study was conducted. A total of 12 APNs working in 6 general practices in German-speaking Switzerland were observed over N= 20 days. The temporal data were treated statistically and descriptively. Results A total of N= 81 activities were observed in seven areas of work. The APNs spend over 40% of their time in direct clinical practice, where they primarily take medical histories and make clinical assessments; however, one third of their time is spent on indirect activities but which arise from their direct work. A total of 26% of the activities observed are consistent with the corresponding regulation in Swiss law and can currently be financed. Discussion Direct clinical practice accounts for a large part of the work performed by APNs. Indirect activities are closely linked to direct clinical practice and cannot be outsourced. Accordingly, the area of indirect activities needs to be redesigned. The regulatory and legal hurdles are substantial and hinder the deployment of APNs in Swiss outpatient primary care. A regulation is urgently needed.
Introduction Primary care in Switzerland is facing major challenges. New care models, e.g., with new roles such as advanced practice nurse (APN), are needed; however, it is not yet well-known in which areas APNs work and how much time they need for their work. In addition, the lack of remuneration for APN activities poses a major challenge for Swiss outpatient primary care. Method A time and motion study was conducted. A total of 12 APNs working in 6 general practices in German-speaking Switzerland were observed over N= 20 days. The temporal data were treated statistically and descriptively. Results A total of N= 81 activities were observed in seven areas of work. The APNs spend over 40% of their time in direct clinical practice, where they primarily take medical histories and make clinical assessments; however, one third of their time is spent on indirect activities but which arise from their direct work. A total of 26% of the activities observed are consistent with the corresponding regulation in Swiss law and can currently be financed. Discussion Direct clinical practice accounts for a large part of the work performed by APNs. Indirect activities are closely linked to direct clinical practice and cannot be outsourced. Accordingly, the area of indirect activities needs to be redesigned. The regulatory and legal hurdles are substantial and hinder the deployment of APNs in Swiss outpatient primary care. A regulation is urgently needed.