PA job satisfaction: Why so happy?

ABSTRACT

A characteristic of physician associates/assistants (PAs) observed consistently is their high degree of career satisfaction. Over 6 decades, national surveys showed that PA job satisfaction levels (either satisfied or very satisfied) consistently were in the mid-80% positive range. This analysis explains this remarkable, consistent, and persistent level of satisfaction among practicing PAs. A review of the literature on PA job satisfaction shows that autonomy in clinical practice appears to be a major correlate with job and career satisfaction.

Burnout, job satisfaction, and turnover intention among primary care nurse practitioners with their own patient panels

BACKGROUND

Nurse practitioners (NPs) can enhance NP care and improve access to care by autonomously managing their patient panels. Yet, its impact on workforce outcomes such as burnout, job satisfaction, and turnover intention remains unexplored.

PURPOSE

To estimate the impact of NP panel management on workforce outcomes.

METHODS

Structural equation modeling was conducted using survey data from 1,244 primary care NPs. NP panel management was categorized into co-managing patients with other providers, both co-managing and autonomously managing, and fully autonomous management.

DISCUSSION

Fully autonomous management led to more burnout than co-managing (B = 0.089, bias-corrected 95% bootstrap confidence interval [0.028, 0.151]). Work hours partially (27%) mediated this relationship. This findings indicate that greater autonomy in panel management among NPs may lead to increased burnout, partially due to longer work hours.

CONCLUSION

Interventions to reduce work hours could help NPs deliver quality care without burnout.

US nurse practitioner voluntary turnover: Development of a framework for analysis

BACKGROUND

There is growing interest in nurse practitioner (NP) turnover with some reports indicating it is as high as 15% annually. However, there is a lack of generalizability and other conceptual weaknesses in the literature. These weaknesses support the development of a framework to operationalize NP turnover for administrators to develop workplace initiatives to reduce turnover.

PURPOSE

To describe the demographic and job characteristics of four NP voluntary turnover groups (i.e., dynamic leavers, static leavers, dynamic stayers, and static stayers) representing voluntary turnover intention and actual turnover among US NPs.

METHODOLOGY

A cross-sectional, descriptive secondary analysis of NPs ( N = 86,632) from the 2018 National Sample Survey of Registered Nurses (NSSRN) was used to delineate and describe four NP voluntary turnover groups.

RESULTS

Nurse practitioners who left nursing (static leavers) were older and had the most work experience. Nurse practitioners who changed jobs and stayed in nursing (dynamic leavers) were younger, less experienced, and reported the least job satisfaction. Nurse practitioners who remained in their positions (stayers) regardless of whether they reported turnover intentions or not earned the most and reported the most job satisfaction.

CONCLUSIONS

Four NP voluntary turnover groups were defined and described to distinguish voluntary turnover intentions from actual turnover.

IMPLICATIONS

Characterizing NP voluntary turnover can help administrators mitigate losses and project organizational needs associated with NP turnover. A framework developed from the 2018 NSSRN can be used to research and develop key initiatives to strengthen the NP workforce.

Colorectal surgery NP fellowship: A transition to autonomy

ABSTRACT

The colorectal surgery advanced practice fellowship was developed for the purpose of providing a successful transition to the colorectal advanced practice specialty and was based on the success of the NP utilization model. The success of the fellowship led to NP practice autonomy, job satisfaction, and retention.

A qualitative study exploring nursing home care environments where nurse practitioners work

Research is needed to support the growing nurse practitioner workforce to assure higher quality care for older adults in nursing homes. Nursing homes with optimal care environments that support nurse practitioner roles, increased visibility, independence, and relationships are better positioned to support care of older adults. This study reports findings of thirteen qualitative interviews with nurse practitioners to explore facets of nursing home care environments and adapt a tool to measure care environments. Our team incorporated deductive and inductive coding to identify three major emerging themes impacting care environments: 1) nurse practitioner practice in nursing homes, 2) overall goals of practice, 3) workplace challenges. Themes were derived from seven overarching categories and 33 codes describing aspects of NH care environment important to nurse practitioners. Some of the most highly important survey items measured nurse practitioner and physician relationships. Less important items measured relationships between nurse practitioners and administration.

Physician assistant and nurse practitioner onboarding in primary care: The participant perspective

BACKGROUND

Many new graduate primary care physician assistants (PAs) and nurse practitioners (NPs) can experience stress and difficulty as they transition to practice. Feelings of anxiety and role ambiguity are common and can lead to costly turnover, impact care continuity, and place patients at risk for poor clinical outcomes. Onboarding, the process of helping new hires adjust to social and performance aspects of their new job and has the potential to ease transition to practice for PAs and NPs. Recent research has linked PA/NP onboarding programs to increased engagement, decreased turnover, and higher clinical productivity.

PURPOSE

To describe new graduate PA and NP perspectives of onboarding programs they completed in their first primary care position.

METHODOLOGY

Thirteen semistructured interviews were conducted with new graduate PAs and NPs who participated in onboarding programs. Interviews were transcribed and then analyzed using an inductive coding methodology.

RESULTS

Analyses revealed nine thematic concepts that are described within two frameworks. Structural components include improving competence, training on the electronic health record, promoting mentorship, orienting to organizational dynamics, tailoring ramp-up of patient scheduling, clarifying expectations, and providing clear organizational support. Psychosocial factors include creating comfort and building self-confidence.

CONCLUSION

Understanding participants' experiences with onboarding programs is essential for ensuring successful transition to practice for new graduate PAs and NPs.

IMPLICATIONS

These findings are beneficial to the health care workforce. Administrators can incorporate these findings into existing and future programs, and new graduate PAs and NPs can negotiate for the inclusion of these components in their first position.

A confirmatory factor analysis of the novice nurse practitioner role transition scale

As interest in supporting new nurse practitioners' (NPs) transition to practice increases, those interested in measuring the concept will need an instrument with evidence of reliability and validity. The Novice NP Role Transition (NNPRT) Scale is the first instrument to measure the concept. The preliminary exploratory factor analysis revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation. Using a cross-sectional design and data from 210 novice NPs, the purpose of this study was to confirm the NNPRT Scale's internal factor structure via confirmatory factor analysis (CFA). The sample was primarily female (97.5%), White (75.9%), and certified in primary care (53.5%). The CFA confirmed the five-factor structure, and model fit was improved by moving and omitting items (χ² [619] = 1277.799, p < 0.001; Root Mean Square Error of Approximation = 0.071 [0.066-0.077]). The final NNPRT Scale includes 37-items, and internal consistency reliability was calculated at 0.95. Convergent validity evidence was supported by a positive, significant correlation with receiving a formal orientation in the first NP position; a negative, significant correlation with turnover intention; and a lack of a relationship with years of prior registered nurse experience. The NNPRT Scale is an instrument with sound evidence of reliability and validity. The NNPRT Scale will be useful for researchers, administrators, and clinicians looking to explore factors that affect NNPRT, as well as by clinicians and administrators implementing programs to support novice NPs' transition to practice.

PA and NP onboarding in primary care: The participant perspective

OBJECTIVE

To describe new graduate physician associate/assistant (PA) and NP perspectives of onboarding programs in their first primary care position.

METHODS

Thirteen semistructured interviews were conducted with new graduate PAs and NPs who participated in onboarding programs. Interviews were transcribed and then analyzed using an inductive coding methodology.

RESULTS

Analyses revealed nine thematic concepts that are described in two frameworks. Structural components are improving competence, training on the electronic health record (EHR), promoting mentorship, orienting to organizational dynamics, tailoring ramp-up of patient scheduling, clarifying expectations, and providing clear organizational support. Psychosocial factors are creating comfort and building self-confidence.

DISCUSSION

The results describe and delineate important components for onboarding that administrators can incorporate into existing and future programs.

CONCLUSION

Understanding participants' experiences with onboarding programs is essential for ensuring successful transition to practice for new graduate PAs and NPs.

Neonatal nurse practitioner job satisfaction, workforce environment, and mental well-being

BACKGROUND

Increased demand for nurse practitioners emphasizes the importance of consistent and ongoing collection of data to provide a better understanding of the NNP workforce and to promote retention and recruitment of NNPs.

PURPOSE

To understand how work environment and work hours influence job or career satisfaction.

METHODOLOGY

The National Association of Neonatal Nurse Practitioners in collaboration with the National Certification Corporation emailed an online survey to all 6,558 certified neonatal nurse practitioners (NNPs) in 2020 with 845 (12.8%) responding. Subjects included those with responsibilities in direct patient care, transport NPs, faculty/directors, and advanced practice registered nurse coordinators/managers/administrators.

RESULTS

Satisfaction with career choice as an NNP was reported as very satisfied by 58% (n = 493) and mostly satisfied by 37% (n = 310). Satisfaction with current job as an NNP was reported as very satisfied for 30% (n = 252), with 51% being mostly satisfied (n = 435). Age influenced satisfaction scores, with NNPs aged 61 years or older having a higher mean score than NNPs aged 31-40 years ( p = .041). The majority of NNPs did not use all of their available paid time off (72%; n = 609) and respondents worked an additional 248 extra hours per year. NNPs experience bullying (58%) and/or lateral violence (32%). Seventeen percent have called in sick for mental health reasons (n = 147).

CONCLUSIONS

Neonatal nurse practitioners' satisfaction is multifactorial. Those who reported taking time off for self-prescribed mental health indicated less job satisfaction, more work hours, poor work/life balance, and a less-than-optimum work environment.

IMPLICATIONS

Overall, NNPs are satisfied with their career choice but are less satisfied with their job choice. Understanding factors that influence mental well-being and job satisfaction will improve recruitment and retention of nurse practitioners.

Job satisfaction of advanced practice nurses in cancer care: A systematic review

PURPOSE

To identify, evaluate, and summarise evidence about advanced practice nurses' (APNs') job satisfaction in cancer care and its related factors.

METHODS

A systematic review was performed including a narrative synthesis. Relevant evidence was identified from searches of three databases: Medline (PubMed), EBSCO (CINAHL), and PsychInfo. This systematic review searched for relevant articles published in English between 2000 and 2020. A structured process according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement was followed. The articles critical appraisal was based on the Mixed-Methods Appraisal Tool. Narrative data synthesis was based on the extracted data (study characteristics, type of questionnaire, level of job satisfaction, related factors, and risk of bias).

RESULTS

Just four articles met the inclusion criteria and were included in the systematic review. Job satisfaction of APNs providing cancer care in different care settings varied from low to high. Satisfying factors were personal, role, work, and institutional factors, whereas dissatisfies included the work setting and stress factors. Different measurement tools of the job satisfaction level were used, which might lead to non-comparable results.

CONCLUSION

The number of included studies and the findings from this systematic review present underinvestigated content according to the influence of patient group demands on APNs' job satisfaction. Evidence of patient group-specific factors relevant to APNs' job satisfaction could not be found. Further research is needed to address the influence of advanced nursing practice and patient group-related factors on job satisfaction.

Reducing Nurse Practitioner Turnover in Home Based Primary Care: A Department of Veterans Affairs Quality Improvement Project

Access to healthcare is challenging for both Veterans and the nation's general population. To keep up with national primary healthcare needs, the Department of Veteran Affairs (VA) implemented Home Based Primary Care (HBPC). After a structure remodel at a Texas VA medical center, 40% of nurse practitioners (NPs) left the HBPC department in one year. The Anticipated Turnover Scale and the Misener NP Job Satisfaction Scale were administered online (n = 7), and results were used to complete a program evaluation. Forty-three percent of participants indicated intent to leave, and 56% of answers indicated job dissatisfaction. Seven categories were identified to mitigate voluntary turnover: Recognition; Shared governance; Orientation; Full practice authority; Collaboration; Organizational workflow maps; and Mentoring. Implementation of recommendations resulting from this project may help retain NPs in both VA and non-VA organizations, reduce organizational costs, support optimal patient outcomes, and increase access to healthcare.

Examining Job Satisfaction and Intent to Stay for Neonatal Nurse Practitioners: The Impact of Mentoring

BACKGROUND

In 2017, the National Association of Neonatal Nurse Practitioners (NANNP) recommended that organizations implement formalized mentoring programs for neonatal nurse practitioners (NNPs). There is significant evidence to support that mentoring positively impacts nurse practitioners' job satisfaction and retention. However, there is a lack of evidence-based literature specific to NNP mentoring.

PURPOSE

Determine the impact of participation in the NANNP formalized mentoring program on job satisfaction and retention for novice and experienced NNPs in an academic medical center in Tennessee.

METHODS

This quality improvement project utilized a secure online survey that included the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and 2 intent-to-stay items prior to implementation of a 6-month mentoring program. Neonatal intensive care unit nurse practitioners completed the same electronic survey at 3 intervals after program implementation to determine the impact of the mentoring program on job satisfaction and intent to stay.

RESULTS

Project results identified a significant difference in MNPJSS scores for participants in a 6-month formal mentoring program using the NANNP tool kit. The MNPJSS scores moderately correlated with intent to stay at 1 year and strongly correlated with intent to stay at 3 years.

IMPLICATIONS FOR PRACTICE

The results of this project support the positive impact of a formalized mentoring program on job satisfaction for new graduate nurse practitioners. Recognizing the challenge to recruit and retain NNPs, organizations should explore creative solutions to develop and support formalized mentoring programs.

IMPLICATIONS FOR RESEARCH

Further research is warranted to validate use of the NANNP tool kit in the establishment and evaluation of a formalized mentoring program.Video abstract available at:https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.

Characterization of Nonphysician Health Care Workers' Burnout and Subsequent Changes in Work Effort

IMPORTANCE

Burnout is a pervasive, unrelenting problem among health care workers (HCWs), with detrimental impact to patients. Data on the impact of burnout on workforce staffing are limited and could help build a financial case for action to address system-level contributors to burnout.

OBJECTIVE

To explore the association of burnout and professional satisfaction with changes in work effort over 24 months in a large cohort of nonphysician HCWs.

DESIGN, SETTING, AND PARTICIPANTS

This longitudinal cohort study was conducted in Rochester, Minnesota; Scottsdale and Phoenix, Arizona; Jacksonville, Florida; and community-based hospitals and health care facilities in the Midwest among nonphysician HCWs who responded to 2 surveys from 2015 to 2017. Analysis was completed November 25, 2020.

EXPOSURES

Burnout, as measured by 2 items from the Maslach Burnout Inventory, and professional satisfaction.

MAIN OUTCOMES AND MEASURES

The main outcome was work effort, as measured in full-time equivalent (FTE) units, recorded in payroll records.

RESULTS

Data from 26 280 responders (7293 individuals aged 45-54 years [27.8%]; 20 263 [77.1%] women) were analyzed. A total of 8115 individuals (30.9%) had worked for the organization more than 15 years, and 6595 individuals (25.1%) were nurses. After controlling for sex, age, duration of employment, job category, baseline FTE, and baseline burnout, overall burnout (odds ratio [OR], 1.53; 95% CI, 1.38-1.70; P < .001), high emotional exhaustion at baseline (OR, 1.54; 95% CI, 1.39-1.71; P < .001), and high depersonalization at baseline (OR, 1.40; 95% CI, 1.21-1.62; P < .001) were associated with an HCW reducing their FTE over the following 24 months. Conversely, satisfaction with the organization at baseline was associated with lower likelihood of reduced FTE (OR, 0.73; 95% CI, 0.65-0.83; P < .001). Findings were similar when emotional exhaustion (OR per 1-point increase, 1.12; 95% CI, 1.10-1.16; P < .001), depersonalization (OR per 1-point increase, 1.10; 95% CI, 1.06-1.14; P < .001) and satisfaction with the organization (OR per 1-point increase, 0.83; 95% CI, 0.79-0.88; P < .001) were modeled as continuous measures. Nurses represented the largest group (1026 of 1997 nurses [51.4%]) reducing their FTE over the 24 months.

CONCLUSIONS AND RELEVANCE

This cohort study found that burnout and professional satisfaction of HCWs were associated with subsequent changes in work effort over the following 24 months. These findings highlight the importance of addressing factors contributing to high stress among all HCWs as a workforce retention and cost reduction strategy.

The Pain Nurse Practitioner and Pain Nurse's Role and Views on Opioid Management in Australia: A National Questionnaire Survey

BACKGROUND

The demand for access to Australian pain management services is growing. The dual crisis of opioid misuse and chronic pain, means pain nurses and nurse practitioners (NPs) have a unique opportunity to meet clinical demands and advance their scope of practice.

AIMS

To understand the role of pain nurses and pain NPs across Australia and explore their perceptions of current opioid management.

DESIGN

This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society.

METHODS

This cross-sectional study involved pain nurses or pain NPs working in Australia who are a members of a pain interest group, which are subgroups of The Australian Pain Society. Survey respondents were contacted via the eight nursing Pain Interest Groups in Australia.

RESULTS

Acute pain management (92.7%) and chronic pain management (80.5%) were the primary services provided, with pain specialty nurses providing nurse education (100.0%), patient support, clinician education, and policy development. Pain nurses believed there was an over prescription of opioid analgesics in Australia (97.6%), with NPs able to reduce opioid medication doses as part of opioid harm mitigation.

CONCLUSIONS

Pain nurses have a breadth of knowledge and experience highlight they can contribute to opioid management in the future, with the support of policy and organizations.

Advanced practice nurse professional advancement programs: a scoping review

OBJECTIVE

The objective of this review was to explore existing literature related to advanced practice nurse professional advancement programs, to examine and map the evidence, and to identify any gaps in the literature.

INTRODUCTION

Internationally, there is literature regarding the implementation and benefits of professional advancement programs for staff nurses, but there is scant literature addressing professional advancement programs for advanced practice nurses. Professional advancement programs may enhance workplace engagement and foster retention by empowering employees to grow and excel.

INCLUSION CRITERIA

This scoping review considered studies that included advanced practice nurses in direct patient care roles participating in professional advancement programs. The concept of the review was advanced practice nurse professional advancement programs and related criteria and characteristics (eg, length of service, performance review, educational preparation) and outcomes (eg, improved recruitment, retention, employee satisfaction). Studies conducted in any setting and geographical location where advanced practice nurses were employed were included.

METHODS

Studies published in English from 1965 to search date were included. The databases searched included PubMed, CINAHL, Embase, Scopus, and PsycINFO. The search for unpublished evidence and gray literature included ProQuest Dissertations and Theses, MedNar, and various hospital websites. Retrieval of full-text studies and data extraction was performed independently by two reviewers. The extracted data is presented in diagrammatic or tabular form with an accompanying narrative summary.

RESULTS

Nine descriptive studies were included in this review. All nine studies detailed the names of advancement programs, and provided characteristics and criteria for advancement for those participating in the programs. In addition, six studies described benefits of advancement, two studies described outcomes associated with advancement, and two studies described outcomes and benefits.

CONCLUSION

There are few advanced practice nurse professional advancement programs discussed in the literature. In the included studies detailing these programs, there were wide variations in the names, criteria, and characteristics. There is also limited data available regarding outcomes associated with advanced practice nurse professional advancement programs.

Organizational empowerment and practice outcomes of acute care nurse practitioners in Taiwan: A national survey

BACKGROUND

Nurse practitioners (NPs) play an important role in addressing growing health care needs. Among NPs, organizational empowerment is positively associated with overall practice outcomes. Therefore, efforts to promote organizational empowerment in practice are necessary to increase job satisfaction among NPs as well as decrease the stress and intention to leave.

PURPOSE

This study investigated the relationships of organizational empowerment and practice outcomes of job satisfaction, work stress, and intention to leave in acute care practices.

METHODOLOGICAL ORIENTATION

This study was conducted as a cross-sectional design with a national survey of 946 acute care NPs. Questionnaires contained demographic and practice characteristics, Misener Nurse Practitioner Job Satisfaction Scale, Condition for Work Effectiveness Questionnaire II, and the work stress VAS scale. Hierarchical Linear Model (HLM) was used to investigate individual NP-level or organization-level effects on job satisfaction. The factors associated with job satisfaction were examined by stepwise multiple regression.

RESULTS

The organizational empowerment was low, work stress was moderately high, and job satisfaction was between slightly unsatisfied and slightly satisfied. The HLM results indicated that organization-level effects did not affect the job satisfaction of NPs. Nurse practitioners with greater formal power, resources, and informal power had higher job satisfaction. Conversely, NPs with an intention to leave and a higher level of stress showed lower job satisfaction.

CONCLUSIONS

Organizational empowerment, intention to leave, and stress affect job satisfaction of acute care NPs in Taiwan.

IMPLICATIONS FOR PRACTIC

To enhance the job satisfaction of NPs, health care administrators should empower NPs by providing access to opportunity, support, information, and resources in the health care delivery system.

Job Satisfaction and Retention of an Advanced Practice Registered Nurse Fellowship Program

The purpose of this study was to determine how an advanced practice registered nurse (APRN) fellowship program affects job satisfaction and retention after the first year of practice. The Misener Nurse Practitioner Job Satisfaction Scale was administered to nine novice APRNs at a large Midwestern children's hospital after program completion. Job satisfaction scores and retention rates were measured. Results indicate that transition-to-practice programs are helpful in bridging the gap between graduation and professional practice as an APRN.

Development of the novice nurse practitioner role transition scale: An exploratory factor analysis

BACKGROUND

Novice nurse practitioner role transition (NNPRT) can be described as stressful and turbulent, leading to decreased job satisfaction and increased intent to leave. No published instrument exists to measure NNPRT. Thus, researchers, educators, and administrators are limited in their ability to measure the concept and therefore understand the factors that lead to a successful, or unsuccessful, role transition experience. An instrument with evidence of validity and reliability is needed to conduct large-scale and systematic examinations of NNPRT.

PURPOSE

The purpose of this study was to develop and examine the initial factor structure of a novel instrument that measures NNPRT.

METHODS

Initial item development was guided by concept analysis, literature review, and qualitative data. Face and content validity were established from expert review. Using pilot data from 89 novice nurse practitioners (NPs), an exploratory factor analysis (EFA) was conducted to examine the instrument's internal factor structure.

RESULTS

The NNPRT Scale includes 40 items that measure an individual's perception of their role transition experience. The EFA revealed a five-factor structure: organizational alignment, mentorship, sense of purpose, perceived competence and self-confidence, and compensation.

IMPLICATIONS FOR PRACTICE

In an evolving health care system, provider well-being is at the center of workforce, educational, and organizational conversations. Understanding how to optimize the workforce and prepare NPs for health care delivery is increasingly important. The NNPRT Scale will allow for large-scale examinations of the factors that influence NP role transition, as well as assess interventions to prepare and support novice NPs' transitions.

Effects of completing a postgraduate residency or fellowship program on primary care nurse practitioners' transition to practice

BACKGROUND

To prepare new graduate nurse practitioners (NPs) for transition to practice, postgraduate residency or fellowship programs have been spreading across the nation in the past decade.

PURPOSE

We examined the effects of completing a postgraduate residency or fellowship program on role perception, practice autonomy, team collaboration, job satisfaction, and intent to leave among primary care NPs (PCNPs).

METHODS

We analyzed 8,400 PCNP respondents, representing a total of 75,963 PCNPs nationwide, to the 2018 National Sample Survey of Registered Nurses. We conducted multivariate logistic regression analyses to examine whether completing a postgraduate training program was associated with increased role perception, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave in their work, controlling for NP personal and practice characteristics.

RESULTS

About 10% of PCNPs completed some form of postgraduate training. Primary care NPs who had completed a residency or fellowship program were more likely to have a minority background (e.g., non-White and male) and also see more underserved populations (e.g., minority background, with limited English proficiency) than those without residency training. We found that PCNPs with residency training were more likely to report enhanced confidence in independent roles, greater practice autonomy, improved team collaboration, increased job satisfaction, and decreased intent to leave than those without residency training.

IMPLICATIONS FOR PRACTICE

This study supports further expansion of such programs, which would have positive effects for NPs, health care organizations, and patients, necessitating a long-overdue conversation about real public funding for primary care graduate nursing education.

Sources of satisfaction, dissatisfaction and well-being for UK advanced practice nurses: A qualitative study

AIMS

To examine and explore organisational and role conditions that promote or inhibit job satisfaction and workplace well-being for advanced practice nurses.

BACKGROUND

The advanced practice role is common across the world. Research shows it is well regarded by patients and improves patient outcomes, but there is little evidence about what the role is like for nurses.

METHODS

A subsample of an existing cohort of advanced practice nurses were invited for interview. Twenty-two nurses were interviewed over the phone. Interviews transcripts were analysed using thematic analysis.

RESULTS

Four themes were derived from the data; 'the advanced nurse role and professional identity', 'feeling exposed', 'support for the advancement of the role' and 'demonstrating impact'.

CONCLUSION

Nurses report considerable dissatisfaction with role identity and concerns relating to isolation on a daily basis, and these negatively affect well-being. However, they also identified significant satisfaction with the role, particularly when well supported and able to recognize the unique contribution that they made to the lives of patients and to their organisations.

IMPLICATIONS FOR NURSING MANAGEMENT

Clear role definitions, provision of high-quality clinical supervision and addressing issues of isolation are likely to improve the job satisfaction of advanced practice nurses.

The millennial engagement, resiliency and retention study: What does your millennial advanced practice registered nurse workforce really want?

BACKGROUND

Increasing the use of advanced practice nurses may be one of the most viable options to meeting the burgeoning health care demands of older Americans and impending provider shortage over the next two decades. However, keeping the millennial workforce engaged and retained continues to be a significant challenge for health care administrators.

PURPOSE

The purpose of this study was to understand the intergenerational advanced practice registered nurse (APRN) workforce and assess what job satisfaction factors impact APRN intention to stay, and explore how variables such as resiliency style and age affect retention in these young careerists.

METHODS

This was a single-center, cross-sectional descriptive study using survey methodology. A total of 405 APRNs from all specialties and practice sites from a large Midwestern Academic Medical Center were eligible to participate. A total of 165 APRNs completed the survey, which was a 41% response rate.

RESULTS

There were no significant differences in mean resiliency scores by age cohort (p > .05) or a higher intention to leave in millennial-aged APRNs versus older APRNs (p > .05); however, there were significant mean differences in job satisfaction responses that warrant consideration in millennial versus older "baby boomer" APRNs on items such as professional growth, compensation, monetary bonuses, and expanding procedures and skills within scope of practice.

IMPLICATIONS FOR PRACTICE

Understanding generational differences in APRN job satisfaction assists hospital leaders to develop strategies to support, engage, and retain younger careerists, which may help mitigate turnover.

Predictors of job satisfaction of registered nurses providing care for older adults

BACKGROUND

The population worldwide is ageing. This has required the nursing profession to respond to the growing demands of providing nursing care to this population.

PURPOSE

To identify predictors of job satisfaction among registered nurses providing care for older adults.

METHODS

A cross-sectional correlational design was used with a convenience sample of nurses. The Quality Work Competence Questionnaire, Job Satisfaction Scale and Nurses' Occupational Stress Scale were used to measure study variables. Descriptive statistics and multiple regressions were used to analyse the data.

RESULTS

The study included 500 nurses; and 68% dissatisfied with their job. Nurses were mostly dissatisfied with the physical conditions in which they work (55.2%) and the rate of payment (50.2%). Physical strain demonstrated the highest positive correlation with nurses' satisfaction (r = .36). More years of experience, skills and employee development, high nurses' competence, and more physical strain predicted high job satisfaction.

CONCLUSION

Job dissatisfaction among nurses providing care for older adults is high and is influenced by nurses' experience, professional development, competency and physical strain.

IMPLICATIONS

Health care organisations should apply strategies that enhance the development of the professional competency of their nursing staff.

Gender differences in nurse practitioners: job satisfaction and patterns of care

BACKGROUND

Although workforce diversity has been cited as an important workforce issue, the contemporary U.S. nurse practitioner (NP) workforce is dominated by females. Provider diversity, specifically gender, has been found to directly influence patient preference. However, lack of gender diversity in the NP workforce has never been specifically evaluated in terms of job satisfaction and patterns of care.

PURPOSE

The purpose of this study was to assess and evaluate NP gender, job satisfaction and practice patterns of care for U.S. clinical NPs.

METHODS

This study used the 2012 National Sample Survey of Nurse Practitioners (NSSNP). Participants meeting inclusion criteria totaled 8,978 NPs, of which 92.8% were female.

RESULTS

Although overall job satisfaction was not shown to be significantly different between genders, several patterns of care were found to be significant. Of the 11 measured patterns of care in the NSSNP, six were significantly different between genders, with a female majority indicating that they performed these services most often. In only one rendered service, performed medical procedures, did male NPs indicate that they did more than females.

IMPLICATIONS FOR PRACTICE

This study suggests the importance of a gender-diversified U.S. nurse practitioner workforce. This is indicated by differences highlighted in patterns of care by NP gender, which has been postulated to influence patient outcomes, including perceived quality of care and engagement in the health care process. Patient preferences for same-gender NPs, particularly patients with privacy issues, warrant further exploration.

Supporting Advanced Practice Providers' Professional Advancement: The Implementation of a Professional Advancement Model at an Academic Medical Center

Organizational commitment to a structured professional advancement model (PAM) is critical for advanced practice provider (APP) development in order to promote and reward excellence, enhance job satisfaction and improve retention and recruitment. A PAM may also serve as a motivational tool for personal and professional growth by developing and promoting a professional, evidence-based collaborative practice environment. A voluntary PAM was implemented at a large Midwestern academic medical center to recognize experienced APPs including certified nurse practitioners, certified nurse-midwives and physician assistants. This manuscript describes the case for creating a PAM, implementation and evaluation.

Nursing practice environment in Primary Health Care: a scoping review

OBJECTIVE

To examine the scientific evidence about the nursing practice environment in Primary Health Care.

METHODS

Three-step scoping review. 1) An initial research on CINAHL and MEDLINE. 2) A broader search using the same keywords and search terms in the remaining EBSCOHost platform databases. 3) Search the bibliographical references of the selected articles. The studies selected were from 2007 to 2018.

RESULTS

19 articles were included, most reported findings of the nursing practice environment and results for clients, nurses, nurse managers and the efficiency of organizations, in Primary Health Care.

CONCLUSION

Improving the environment of nursing practice has consequences on the quality of nursing care, with increased results for clients, nursing and Primary Health Care.

Job satisfaction among oncology nurse practitioners

BACKGROUND

One proposed solution to the predicted shortage of oncology nurse practitioners (NPs) is expanding the role of the oncology NP. However, role expansion may lead to an increase in work-related stress and a decrease in job satisfaction. It is important to understand oncology NPs' job satisfaction and stress and their intent to leave their job or profession in order to further develop and potentially expand the role.

PURPOSE

The purpose of this study is to determine the main factors that affect job satisfaction, especially the relationship with stress and the intent to leave the oncology specialty.

METHODS

A convenience sample of responses to a series of surveys administered by the Oncology Nursing Society and residing in the ONS database was used for this analysis. Exploratory data analysis, principal component analysis, and regression models were applied to explore characteristics of the questionnaires, assess the reliability of the Coping Skills Questionnaire, and find out main factors for their intent to leave.

RESULTS

Items in the Coping Skills Questionnaire were internally consistent, and stress had a positive effect on NPs' intent to leave. Satisfaction and coping skills were also significant in some models; higher levels of satisfaction and coping skills resulted in lower levels of intent to leave. Moreover, several demographic factors such as having children, schedule days off, and patient population also affected the response significantly.

IMPLICATIONS FOR PRACTICE

This study provides nursing leaders with information to guide retention of NPs.

Exploring novice nurse practitioner job satisfaction

BACKGROUND

With the continued increase in new nurse practitioners expected over the next 5 years and beyond, more individuals will experience nurse practitioner role transition. It is beneficial to nurse practitioners, patients, and the health care industry to understand factors relating to job satisfaction during role transition.

PURPOSE

The purpose of this study was to contribute to the understanding of the transition period of new nurse practitioners by exploring demographics and job satisfaction during the first 6 months to 2 years of practice.

METHODS

This nonexperimental quantitative study employed convenience sampling with survey methodology. Twenty-one Facebook groups/pages were posted on once a week for 6 weeks. Demographic information was collected, and personal experiences were measured with the Misener Nurse Practitioner Job Satisfaction Scale.

RESULTS

Practice setting, formal orientation programs, and intent to leave current position were related to overall nurse practitioner job satisfaction during the transition period (p < .05). Satisfaction with time and benefits varied among demographic groups (p < .05).

IMPLICATIONS FOR PRACTICE

Novice nurse practitioners are mostly satisfied in their new role. However, turnover intention in this population is high and orientation programs are lacking, warranting further study.

Interest in Medication and Aspiration Abortion Training among Colorado Nurse Practitioners, Nurse Midwives, and Physician Assistants

OBJECTIVES

We examined advanced practice clinicians' (APCs: nurse practitioners [NPs], certified nurse midwives [CNMs], physician assistants) interest in training to provide medication and aspiration abortion in Colorado, where abortion provision by APCs is legal.

METHODS

We surveyed a stratified random sample of APCs, oversampling women's health (CNMs/women's health nurse practitioners [WHNPs]) and rural APCs. We examined prevalence and predictors of interest in abortion training using weighted χ2 tests.

RESULTS

Of 512 participants (21% response), the weighted sample is 50% NPs, 41% physician assistants, and 9% CNMs/WHNPs; 55% provide primary care. Only 12% are aware they can legally provide abortion. A minority of participants disagree that medication abortion (15%) or aspiration abortion (25%) should be in APC scope of practice. Almost one-third (29%) are interested in medication abortion training and 16% are possibly interested; interest is highest among CNMs/WHNPs (52%) (p < .01). Interest in aspiration abortion training is 15% with another 11% who are possibly interested; interest is highest among CNMs/WHNPs (34%) (p < .01). There are no significant differences in abortion training interest by rural practice location or by receipt of abortion education in graduate school. Participants not interested in medication and aspiration abortion training cited abortion being outside their specialty practice scope (44% and 38%, respectively) and religious or personal objections (42% and 34%). Among clinicians interested in medication abortion training, 33% believe their clinical facility is likely to allow them to provide this service, compared with 16% for aspiration abortion.

CONCLUSIONS

Interest in abortion training among Colorado APCs is substantial. However, facility barriers to abortion provision must be addressed to increase abortion access with APCs.

Mayo Clinic Hematology Fellowship for Advanced Practice Providers

Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), are part of a growing cancer care workforce. Current hematology-specific education provided by most graduate NP and PA school educations is limited. Mayo Clinic School of Health Sciences launched a hematology-specific fellowship in 2018 to provide APPs with the skills and knowledge required to deliver high-quality specialty care in hematology and blood and marrow transplant (BMT). The fellowship curriculum was developed based on a needs-based assessment study as well as the qualitative reported experiences of current hematology-specific APPs. The curriculum contains didactic in-class education, research opportunities, and mentored clinical rotations in both inpatient and outpatient practice in hematology and BMT. This 12-month fellowship, one of the only postgraduate training programs dedicated to benign and malignant hematology practice, provides structured training for highly qualified graduate APPs interested in developing a rewarding career in hematology.

A concept analysis of nurse practitioner autonomy

BACKGROUND

Nurse practitioner (NP) autonomy is often misunderstood and misconstrued. These misconceptions cause a confusing interplay of words that impedes advocating for policy change and ultimately hinders the profession.

OBJECTIVE

To develop a clear definition of NP autonomy to describe the professional role.

DATA SOURCES

Walker and Avant's method of concept analysis was used to undertake a concept analysis of NP autonomy. The terms used to search for possible uses and definitions of NP autonomy in electronic databases included NP, autonomy, and concept analysis. In addition, the websites for nursing organizations, Google, Google Scholar, and the Merriam-Webster dictionary were searched and included in this analysis. This search yielded 29 articles, consisting of literature reviews, meta-synthesis, position papers, and qualitative and quantitative studies.

CONCLUSIONS

Nurse practitioner autonomy should be defined as the NP's use of their experience, clinical judgment, and responsibility to practice without restriction in professional collaboration with other health care professionals. Autonomy allows NPs to practice to the maximum extent of their advanced education, participate in productive and voluntarily collaborations, and continue to positively influence health care discrepancies throughout the United States.

IMPLICATIONS FOR PRACTICE

This concept analysis provides a clear definition of NP autonomy. In addition, it explains the difference between the concepts of NP autonomy and full practice authority. Clear definitions of the concepts of NP autonomy and full practice authority will be beneficial in advocating and advancing policy on behalf of NPs.

Pediatric nurse practitioner's perceived organizational support in academic and nonacademic institutions

BACKGROUND

The role of the pediatric nurse practitioner (PNP) has changed since its inception over 50 years ago. Pediatric nurse practitioner practice has evolved from providing outpatient primary care to children to providing complex care in the acute practice environment.

PURPOSE

The purpose of this study was to describe whether a difference existed in perceptions of organizational support (POS) of PNPs working in academic and nonacademic institutions and to describe the differences between PNP reporting structures and POS.

METHODS

A quantitative cross-sectional design was used with a convenience sample (n = 86) of PNPs from the membership list of the Pediatric Nurse Credentialing Board (PNCB). A formal written request was sent to the PNCB to access their membership after which institutional review board approval was obtained from Case Western Reserve University. Participants received an online cover letter with links to the surveys to be completed. The PNPs were asked to complete a demographic/institution characteristic survey and Eisenberger Perceived Organizational Support Survey (POS).

RESULTS

More than 63% of the PNPs participating in this national survey, practicing in both academic and nonacademic affiliated hospitals, had positive perceptions of organizational support. No differences were found between the academic and the nonacademic affiliations.

IMPLICATIONS FOR PRACTICE

Because PNPs are integral to the provision of care to children, providing opportunities for PNPs to continue to enhance their clinical skills and practice to the full extent of their scope of practice will only enhance their perceptions of organizational support. This dynamic creates a win-win for the PNP, the institution, the patients they care for, and the US health care system.

Facilitators and barriers to the novice nurse practitioner workforce transition in primary care

BACKGROUND AND PURPOSE

Little is known about the facilitators and barriers to the workforce transition of novice nurse practitioners (NPs) in primary care. This research aimed to identify factors contributing and detracting from a successful initial workforce transition for novice NPs in the primary care setting.

METHODS

A descriptive, cross-sectional study was conducted via online survey administered to a national sample of 177 NPs who graduated from an accredited NP program and were practicing in a primary care setting for 3-12 months. Open-ended responses were analyzed using the Krippendorff content analysis method.

CONCLUSIONS

This study demonstrated that facilitators of the novice NP transition are the presence of mentorship and social support, finding meaning in their work, job satisfaction, and work-life balance. Barriers to the novice NP transition are lack of support and respect, role ambiguity, and workload.

IMPLICATIONS FOR PRACTICE

More mentorship, support, role clarity, and respect are needed to facilitate the novice NP workforce transition. More research is needed on interventions that can be implemented by health care organizations to improve the facilitators of role transition identified in this study.

Professional Satisfaction of Advanced Practice Providers in Primary Care Specialties

EXECUTIVE SUMMARY

This prospective study focuses on professional satisfaction among advanced practice providers (APPs) in primary care. We aimed to determine whether incorporating specialty care clinics within primary care practices increases professional satisfaction. We administered the validated Misener Nurse Practitioner Job Satisfaction Scale and a self-developed demographic questionnaire to all primary care APPs before and one year after implementation of a gynecology practice within the primary care setting. APPs practicing in a dual-role specialty practice reported higher overall professional satisfaction; professional growth; intrapractice partnership/collegiality; professional, social, and community interaction; and benefits than their primary care-only counterparts. We concluded that professional satisfaction among APPs may contribute to staff retention.

Nurses' Remaining in Everyday Nursing Practice-A Comprehensive Model

Previous theoretical and empirical models of nurses' remaining in everyday nursing practice are explained by elements such as intent to stay and desire to stay. This study provides a model that expands or expresses an increased understanding of the comprehensiveness of the issue by pointing to the qualitative worth of different desires. The aim of this study is to describe a comprehensive model of nurses' remaining in everyday nursing practice. This study was designed in three sequential stages: first, the empirical foundation of the model; second, the development of the model; and third, the description of the model. The described model is derived from a previous qualitative study's comprehensive understanding of empirical findings. That original study was based on a hermeneutical approach, the aim of which was to understand what is of significance for nurses to remain in everyday practice. The collected data consisted of qualitative interviews and qualitative follow-up interviews with 13 nurses. The research context was the primary and secondary somatic and psychiatric health service. The present comprehensive model is stated in a simple structure, which nonetheless provides a relevant framework for constituent elements of nurses' remaining in everyday practice. Horizons of identity and self-understanding have been identified as constituent elements or key concepts involved in remaining. By focusing on a deepened and broader understanding, the model highlights that remaining may be constituted through a process of identification and taking standpoints, which in turn has a potential to empower nurses to realize themselves.

High-Fidelity Simulation: An Application to Psychopharmacological Training for the Psychiatric Nurse Practitioner Student

As the demand for Psychiatric Mental Health Nurse Practitioners (PMHNPs) continues to grow, innovative teaching strategies that can enhance competency learning with skill transfer into the clinical setting is essential. Educational programs must adequately prepare the student for the complexity of the clinical environment. Simulation is an educational approach that replicates aspects of the real world in a safe environment so that learners can engage in an interactive manner. High-fidelity simulation (HFS) has been identified as an effective teaching strategy and mechanism to transfer knowledge and skills learned in the classroom to the clinical setting. HFS uses a human patient simulator to immerse the learner in a contextual learning environment by engaging in a realistic clinical scenario to develop cognitive, affective and psychomotor skills through deliberate practice. This article describes the theoretical foundation, development process, case scenarios, and implementation of HFS, an innovative teaching pedagogy, in a Psychopharmacology didactic course for PMHNP.

Competency-based Professional Advancement Model for Advanced Practice RNs

The process of developing a 3-tiered advanced practice RN (APRN) competency-based professional advancement model at Boston Children's Hospital is described. The model recognizes the contributions of entry-level and expert APRNs to advanced clinical practice and outcomes, impact, and leadership, while incorporating the tenets of Patricia Benner's Novice to Expert Model and the American Association of Critical- Care Nurses Synergy Model of Care.

American Association of Nurse Practitioners National Nurse Practitioner sample survey: Update on acute care nurse practitioner practice

BACKGROUND AND PURPOSE

Data from national surveys on the practice of nurse practitioners (NPs) provides valuable information on aspects of practice, demographic characteristics of providers and patients, plans for continued employment, and role satisfaction. The American Association of Nurse Practitioners (AANP) has been conducting the AANP Sample Survey since 1988.

METHODS

The most recent AANP Sample Survey was conducted in 2016 with a random stratified survey of 40,000 NPs. Data were collected bimodally, by internet and mail surveys. Responses were received from 3,970 respondents (9.9% response rate), with 335 respondents reporting NP certification in acute care as adult-gerontology acute care and/or pediatric acute care.

RESULTS

Almost all acute care nurse practitioners (ACNPs) reported that they were clinically practicing in 2016 (99.3%), with the top three areas encompassing cardiovascular (20.5%), critical care (12.1%), and hospitalist roles (6.3%). More than 1 in 4 ACNPs worked in a hospital inpatient setting, with 16.1% reporting work in a hospital outpatient clinic, 7.7% in a private group practice, 6.5% at a public university, and some in combined roles covering both inpatient and outpatient care, or on consultation service or specialty-based teams. On average, 34.1% of the patients ACNPs saw were between the ages of 66 and 85 years, and 11.2% were 85 years and older. The top 3 medication classes in which ACNPs regularly prescribe were diuretics (31.9%), analgesic narcotics (31.2%), and antibiotics (27.3%). Majority (88%) report satisfaction with the role, and approximately one third (31.1%) expect to continue to work in their current practice for more than 10 years.

IMPLICATIONS FOR PRACTICE

The findings of the 2016 AANP National NP Sample Survey data related to ACNP practice identify expansion of work settings, practice consistent with acute care scope of practice, role satisfaction, and intent to continue working. Continued monitoring of practice components and employment is indicated to track ACNP workforce trends.

Predictors of nurse practitioner retention

BACKGROUND AND PURPOSE

Increased utilization of nurse practitioners (NPs) has been proposed to reduce the shortage of primary care providers, so identifying factors related to retention of NPs is important for health care organizations. The purpose of this study was to examine the relationship of Misener Nurse Practitioner Job Satisfaction Scale factors and nurse demographic characteristics with NP retention, as defined by the number of years at the current position and intention to leave the current position within 5 years.

METHODS

A survey was distributed via email to members of the Texas NP Organization.

CONCLUSIONS

Three hundred fifteen NPs participated in the study. Years of experience (p < .001), salary (p = .018), and benefits (p = .007) were significantly associated with longer duration of employment at the current position, after controlling for the other variables in the linear regression model. After adjusting for the other variables in the logistic regression model, higher challenge/autonomy factor scores (p = .016) and higher annual salary (p = .032) were associated with significantly lower odds of intention to leave the current position within 5 years.

IMPLICATIONS FOR PRACTICE

Interventions to increase NP autonomy and facilitate employment in positions with more competitive salaries are likely to improve NP retention.

Magnitude of Turnover Intention and Associated Factors among Health Professionals Working in Public Health Institutions of North Shoa Zone, Amhara Region, Ethiopia

BACKGROUND

Health workers are one of the most important building blocks of the health system. High turnover rate contribute to the shortfalls and unbalanced distribution of health personnel in the health workforce. Turnover intention is the strongest predictor of actual turnover.

OBJECTIVE

To assess the magnitude of turnover intention and associated factors among health professionals working in public health institutions of North Shoa Zone, Amhara region, Ethiopia.

METHODS

A health facility based cross-sectional study was conducted from March to April 2016, on 612 health professionals working in public health institutions of North Shoa Zone, Amhara region, Ethiopia, using a multistage stratified sampling technique. Data were collected using a pretested self-administered structured questionnaire. The data were entered using Epidata version 3.1 and analyzed using SPSS version 22 software. Descriptive statistics were conducted to summarize the sample characteristics. Backward stepwise logistic regression model was fitted and AOR with 95% CI was calculated to identify the associated factors. P-value <0.05 was taken as a cut-off point for statistical significance. Ethical issues were addressed.

RESULTS

Among the 568 health professionals who responded to the questionnaire, 348 (61.3%) of them reported to have the intention to leave their current workplaces. The results showed that being a male [AOR = 1.496 (95% CI: 1.016, 2.204)], medical doctor [AOR = 0.318 (95% CI: 0.122, 0.824)], unsatisfied with the work nature [AOR = 1.822 (95% CI: 1.206, 2.753)], unsatisfied with the incentives [AOR = 1.668 (95% CI: 1.105, 2.517)], and unsatisfied with the supervision [AOR = 1.916 (95% CI: 1.274, 2.881)] and having low normative commitment [AOR = 2.176 (95% CI: 1.482, 3.196)] were significantly associated with turnover intention of the health professionals.

CONCLUSIONS

The magnitude of turnover intention was high among health professionals working in public health institutions of North Shoa Zone. Health service managers and policymakers should develop evidence based retention strategies considering the determinants of health professionals' intention to leave.

Correlation between nursing managers' leadership styles and nurses' job stress and anticipated turnover

AIM

To investigate the relationship between leadership style with nurse job stress and anticipated turnover.

BACKGROUND

An appropriate leadership style should promote the efficacy of nurses. Different leadership styles can affect nurse's job stress and the numbers of nurses leaving their workplace or their profession.

METHODS

In this cross-sectional correlational study, 1,617 nurses were selected from the governmental hospitals in Iran 2016-2017. Data were analyzed using descriptive and inferential statistics in SPSS₂₀ .

RESULTS

Nursing Manager's leadership style was transactional leadership. Both transformational and transactional leadership style have a significant relationship with job stress and anticipate staff turnover. A positive relationship was found between a laissez-faire leadership style with job stress and anticipated turnover.

CONCLUSION

The transformational and transactional leadership styles can reduce nurse's job stress and intention to leave, so nurse leaders can use combination of transformational and transactional leadership for improving job satisfaction and quality of nursing services.

IMPLICATIONS FOR NURSING MANAGEMENT

Leaders should emphasize a clear expression of values, objectives, and mission of the organisation; and try to raise confidence in employees, respecting and caring for them, supporting their views and suggestions, and being optimistic about the future.

Primary Care Nurse Practitioner Wage Differences by Employment Setting

BACKGROUND

Previous studies reported that primary care nurse practitioners working in primary care settings may earn less than those working in specialty care settings. However, few studies have examined why such wage difference exists.

PURPOSE

This study used human capital theory to determine the degree to which the wage differences between dingsPCNPs working in primary care versus specialty care settings is driven by the differences in PCNPs' characteristics. Feasible generalized least squares regression was used to examine the wage differences for PCNPs working in primary care and specialty care settings.

METHODS

A cross-sectional, secondary data analysis was conducted using the restricted file of 2012 National Sample Survey of Nurse Practitioners.

FINDINGS

Oaxaca-Blinder decomposition technique was used to explore the factors contributing to wage differences.The results suggested that hourly wages of PCNPs working in primary care settings were, on average, 7.1% lower than PCNPs working in specialty care settings, holding PCNPs' socio-demographic, human capital, and employment characteristics constant. Approximately 4% of this wage difference was explained by PCNPs' characteristics; but 96% of these differences were due to unexplained factors.

DISCUSSION

A large, unexplained wage difference exists between PCNPs working in primary care and specialty care settings.

Practice environments and job satisfaction and turnover intentions of nurse practitioners: Implications for primary care workforce capacity

BACKGROUND

Health care professionals, organizations, and policy makers are calling for expansion of the nurse practitioner (NP) workforce in primary care to assure timely access and high-quality care. However, most efforts promoting NP practice have been focused on state level scope of practice regulations, with limited attention to the organizational structures.

PURPOSE

We examined NP practice environments in primary care organizations and the extent to which they were associated with NP retention measures.

METHODOLOGY

Data were collected through mail survey of NPs practicing in 163 primary care organizations in Massachusetts in 2012. NP practice environment was measured by the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has four subscales: Professional Visibility, NP-Administration Relations, NP-Physician Relations, and Independent Practice and Support. Two global items measured job satisfaction and NPs' intent to leave their job. We aggregated NP level data to organization level to attain measures of practice environments. Multilevel logistic regression models were used.

FINDINGS

NPs rated the relationship between NPs and physicians favorably, contrary to the relationship between NPs and administrators. All subscales measuring NP practice environment had similar influence on the outcome variables. With every unit increase in each standardized subscale score, the odds of job satisfaction factors increased about 20% whereas the odds of intention of turnover decreased about 20%. NPs from organizations with higher mean scores on the NP-Administration subscale had higher satisfaction with their jobs (OR = 1.24, 95% CI [1.12, 1.39]) and had lower intent to leave (OR = 0.79, 95% CI [0.70, 0.90]).

PRACTICE IMPLICATIONS

NPs were more likely to be satisfied with their jobs and less likely to report intent to leave if their organizations support NP practice, favorable relations with physicians and administration, and clear role visibility. Creating productive practice environments that can retain NPs is a potential strategy for increasing the primary care workforce capacity.