Assessing the role and employability of military advanced practitioners in deployed pre-hospital setting: a qualitative interview study

Abstract

Introduction: previous research in the UK civilian sector indicates that advanced practitioner (AP) roles could significantly enhance the Defence workforce by addressing increasing healthcare demands in austere and remote environments. Defence Medical Services (DMS) could deploy APs to deliver pre-hospital emergency care (PHEC) on operations, potentially improving patient outcomes in resource-limited settings. While the DMS has trained a few APs, limited research defines their operational role. This study assesses whether military APs can contribute to the deployed pre-hospital workforce.

Methods: qualitative, semi-structured interviews were conducted with 10 military APs and 12 non-AP healthcare professionals (paramedics, nurses and doctors) purposively sampled from the DMS PHEC subspecialty board. The study explored the roles, experiences and challenges of military APs and examined non-APs’ perceptions of their employability and integration within DMS. Data were thematically analysed, focusing on role clarity, collaboration and the operational impact of APs.

Results: there were three main themes: ‘Understanding the gaps, training and career challenges for military APs’; ‘Building trust and managing boundaries in multi-professional teams’; and ‘Exploring future roles and employment of military APs’. Participants recognised the potential of military APs to operate autonomously in remote locations. Trust fostered through mentorship and collaborative relationships emerged as essential for APs’ autonomy and professional growth. However, hierarchical structures within military and medical systems presented challenges, highlighting the need for clearer career management and role identification for APs. Participants advocated for standardising AP roles, aligned with civilian practices, to ensure consistency in roles and expectations. Participants suggested that military APs could enhance care delivery in prolonged field care and critical care retrieval, particularly in PHEC Level 8 teams. APs perceived their role offered enhanced flexibility to the PHEC workforce.

Conclusion: to maximise AP potential, the DMS must continue fully developing an AP strategy with workforce implementation. APs offer opportunities to bridge gaps in operational care, improve patient outcomes and support clinical career progression for nurses and paramedics.

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Identifiers

ORCID for Jane Prichard: orcid.org/0000-0001-7455-2244

ORCID for Joanne Turnbull: orcid.org/0000-0002-5006-4438

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