Integration of Nurses in General Medicine Practices and General Practitioners’ Satisfaction: Systematic Scoping Review

Objectives: Integration of nurses into primary care (PC) has shown favorable effects on patient outcomes; however, the extent and diversity of available literature on general practitioner (GP) satisfaction are unknown. We aimed to gather, map and summarize all available peer-reviewed evidence about GPs' satisfaction. Methods: We searched for all observational and intervention studies about integration of nurses into practices in Medline, Embase, PsychINFO, Cochrane Central, ProQuest, CINAHL, Web of Science, with quantitative, qualitative, or mixed methods (outcome GP job satisfaction). Results: Two independent reviewers selected 31 studies out of 2562, including 8600 GPs (sample size 3 - 2013). The main outcome was GP satisfaction in 21 studies, GP satisfaction and workload (N=7), GP satisfaction and retention (N=1), and GP satisfaction, burnout and retention (N=2). There were 11 qualitative studies, 10 quantitative descriptive studies, 7 mixed methods studies, 2 randomized controlled trials, and 1 quantitative non-randomized trial.Outcome results were globally positive in 18 studies (58%), mixed in 10 (32%), unchanged in 2 (6%), and unfavorable in 1 (3%). In some studies, GPs expressed concerns about cost-effectiveness, reimbursement of shared care, medico-legal implications (ultimate responsibility with the GP), restrictive payment policies, loss of GP autonomy. Factors of GP satisfaction included gain of time; improved work/life balance for themselves; and gain of services offered to patients, especially in preventive and chronic care.Overall, the results suggest that there should be a clear understanding and agreement on the role of the practice nurse by all stakeholders. Conclusion: