Nurse Practitioners Adding Value to the Care of Vulnerable Populations

Abstract

Aim: To explore stakeholders’ perceptions of primary healthcare nurse practitioners’ (PHCNPs) added value in caring for people in vulnerable situations, and how contextual characteristics shape these perceptions, using two Québec clinics serving refugee and asylum-seeking populations as cases. Background: People in vulnerable situations experience intersecting clinical, social, linguistic, financial, and structural barriers to primary healthcare. Refugee and asylum-seeking populations represent one context in which these vulnerabilities challenge conventional service models. Although PHCNPs are recognized for their holistic approach, empirical evidence on their added value remains limited, from patient, clinical staff, and decision-maker perspectives. Methods: A qualitative descriptive multiple case study was conducted in two Québec primary healthcare settings: a non-urban refugee clinic and an urban clinic serving refugee and asylum-seeking populations. Data collected from July to December 2023 included 47 semi-structured interviews and sociodemographic questionnaires, 43 hours of non-participant observations, five organizational documents, and field notes. Intra- and cross-case thematic analyses used inductive and deductive coding. Findings: Stakeholders perceived PHCNPs as key contributors to patient care, interdisciplinary teams, and the healthcare system. Their added value was linked to holistic, person-centred practice, expanded scope, care coordination, and responsiveness to complex needs. Although scopes of practice were similar across sites, role enactment varied according to patient sociodemographic characteristics, organizational context, and team functioning. Case 1 showed stronger team cohesion, whereas Case 2 involved more fragmented team functioning but greater perceived gains in efficiency and staff job satisfaction. Across both sites, perceived outcomes included high patient satisfaction, improved health perceptions, better access to care, and perceived cost-effectiveness. Conclusion: PHCNPs’ perceived added value lies in combining advanced clinical practice with holistic, person-centred care, professional development, and contributions to team functioning. Context shapes how this value is enacted and perceived, informing policy, education, research, and practice to improve equitable access for people in vulnerable situations.