Table 4 Case vignettes: Role anchoring and development

Building trust and raising awareness

I wish for conversations, persuasive efforts and positioning, for instance concerning the nurses at residential long-term care facilities, they will become fewer in number, that it will suddenly become self-evident that we exist and what our role is. (APN_3, interview)

With certain [patients] I don’t know if it is that present or evident that I am actually performing the role of APN. [...] So even though I explain at the beginning and the GP introduces me as such - and I keep saying it - to some I am the medical practice assistant; to others I am an GP, and this needs repeated correction. And afterwards I realize, they don’t actually care what my title is or what kind of education I have. To them what matters is what I do for them, and if they have the confidence in me that I will take care of it. (APN_3, interview)

Participating in quality assurance and reflection

[In patient conferences,] GPs learn, how can I collaborate with an APN? Which duties can I delegate? How are controls to be implemented? How can we divide these job groups, so [it] is safe from an implementation perspective, so that the GPs can bear the responsibility (which they still have), so that everything is all right for patients and their family members? (APN_4, interview)

GP during a patient conference: 'The APN has the focus on the resident, which is completely right. I don’t have to be on-site to make the diagnosis. It is either an infarct or a hemorrhage. But to the resident and the family members it is important for someone to be on-site. A process has been initiated. The family can now take a step, if they wish to do so. As an APN she is perfectly suited for such situations. [...] the GP would be under much more time pressure.' (APN_3, go-along)

Giving and receiving further education

[It] is a little bit my hope that somehow, based on the Seeland example, the APN role in the primary health care system can also be transferred. [...] I believe the basic idea that the way we practice here is surely something that people can profit from everywhere. And it would be lovely if it could happen this way someday, that [this care model] would be self-evident. (APN_3, interview)