Hiring and Credentialing of Nurse Practitioners as Hospitalists: A National Workforce Analysis

An evaluation of nurse practitioner and physician assistant hiring patterns after implementation of the advanced practice registered nurse consensus model

ABSTRACT

The Advanced Practice Registered Nurse (APRN) Consensus Model was developed in 2008 by the APRN Consensus Work Group and the National Council of State Boards of Nursing APRN Advisory Committee. This model aims to improve access to APRN care through standardization of licensure, accreditation, certification, and education and has been adopted by many organizations throughout the United States. However, the Consensus Model is not a legislative document, and there is variation in adoption and implementation throughout states and organizations. Since the Consensus Model was developed, little is known about how this change has affected hiring practices for nurse practitioners (NPs) and physician assistants (PAs). There are concerns that the model may place burdensome hiring constraints on NP hires, which could inadvertently lead to preferential hiring of PAs over NPs. We evaluated whether there was a significant association between the proportion of NPs versus PAs hired after the implementation of the APRN Consensus Model in 2017 in a large not-for-profit health system in North Carolina. Our study revealed no association between implementation of hiring practices to align with the APRN Consensus Model and preferential hiring of PAs over NPs.

Nurse practitioner hospitalists: An empowered role

BACKGROUND

Nurse practitioners (NPs) are increasingly employed by hospital medicine groups and contribute to the care of the hospitalized adult patient. Prior research indicates NP hospitalists are empowered in their role.

PURPOSE

This national study describes the work experience of the NP hospitalist workforce.

METHOD

A qualitative exploratory study using five focus group sessions with NP hospitalists is described using thematic analysis and synthesis of transcriptions. Inductive coding identified and further refined themes explained by NP hospitalist participants.

FINDINGS

Psychological empowerment was reaffirmed as the overarching theme to describe the experience of NP hospitalists. Five subthemes of this empowerment emerged: collegiality, autonomy, role preparation, the road traveled, and pathfinder.

DISCUSSION

Three main implications of the study include: the need for educational programs to align with practice; hospital bylaws require updating to support current practice; and the APRN Consensus Model does not fully reflect hospitalist roles.

Characteristics and perceptions of the US nurse practitioner hospitalist workforce

BACKGROUND

The use of nurse practitioners (NPs) as hospitalists has grown over the last two decades. Based on current educational preparation, certification, and scope of practice, the acute care NP is considered by professional standards the best prepared to care for the needs of acutely and critically ill patients. Little is known about this sector of the NP workforce.

PURPOSE

The study was designed to identify the NP hospitalist workforce's characteristics and describe the NP hospitalist workforce's perception of the work environment.

METHODS

We deployed five questions in the 2019 American Association of Nurse Practitioners National NP Sample Survey. Of 880 respondents working in an eligible inpatient setting, 366 responded that they work as hospitalists caring for adult patients.

RESULTS

Most respondents (n = 275, 74.7%) were certified in primary care. On-the-job training was the most common qualification to be an NP hospitalist (n = 274, 75%). The majority (n = 252, 68.9%) had a collaborative relationship with a physician at their site. Job satisfaction was significantly correlated with full utilization of one's education and practicing to the fullest extent of the state's scope of practice with an r(360) = .719, p = .00 (two-tailed).

IMPLICATIONS FOR PRACTICE

The prevalence of on-the-job training as the most common preparation for the hospitalist role suggests a need to evaluate the effectiveness and outcomes of NPs not initially educated as acute care NPs who work as hospitalists. Nurse practitioner educators should address the evolving workforce needs of both primary and acute care practice when planning and implementing educational programs.