Co-Designing Nurse Practitioner Roles in a Tertiary Hospital: A Qualitative Exploration of Patterns and Underlying Dynamics

To explore patterns and dynamics during the co-design process of nurse practitioners' role development in three departments in a Belgian tertiary hospital. Participatory action research was utilised in conjunction with principles of a Grounded Theory approach to explore patterns and dynamics. Sixteen meetings were conducted between January and June 2021 with interdisciplinary teams to develop the roles. Thirteen exploratory interviews were held with the stakeholders involved between March and June 2022. All meetings and interviews were recorded and transcribed verbatim. Data were systematically analysed using researcher triangulation and thematic analysis. Stakeholders' initial conception of the nurse practitioner roles affected development. A dynamic interplay of individual, team-related and contextual (e.g., financial and legal) factors shaped these conceptions. Through co-design, stakeholders' conception evolved as insights were shared, misconceptions challenged and perspectives broadened. Physicians generally the developmental process, while nursing leadership was more fragmented. This study identifies patterns and dynamics in interdisciplinary teams during the developmental process. The key findings underpin the crucial role of stakeholders' conceptions, use of co-design and leadership in this process. Therefore, a thorough understanding of initial conceptions is ess, and efforts should be directed towards providing sufficient knowledge and experience to prevent misconceptions. Additionally, this study emphasises the significance of a balanced team composition that incorporates diverse conceptions of the role. Finally, actions should be taken to empower leadership among nurses. Identified dynamics offer insights for healthcare organisations developing nurse practitioner roles. Educational institutions can use these insights to enhance healthcare professionals' curricula, preparing healthcare professionals for evolving advanced nursing roles and leadership. Additionally, it emphasises the necessity for policy work to establish a legal framework for nurse practitioners in Belgium. The 'Standards for Reporting Qualitative Research' were used for reporting. This study did not involve direct participation from patients or the public.