1
|
Turi E, McMenamin AL, Courtwright S, Martsolf G, Liu J, Hasin D, Poghosyan L. Nurse Practitioner Work Environment and Rural Primary Care for Substance Use. J Nurse Pract 2024; 20:105152. [PMID: 39131540 PMCID: PMC11308990 DOI: 10.1016/j.nurpra.2024.105152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
We examined the relationship between the nurse practitioner (NP) work environment and realized access (i.e., utilization) to primary care among rural older adults with substance use disorders (SUD). We analyzed cross-sectional NP survey data merged with Medicare claims and utilized fractional logistic regression. With one unit improvement in NP work environment, the odds of having older adults with SUDs in the practice increased by 20% (adjusted odds ratio=1.20, 95% confidence interval=1.01-1.44, p=0.04). Favorable work environments for NPs, including organizational support, collegiality, and role visibility, are associated with increased realized access to primary care among rural older adults with SUDs.
Collapse
Affiliation(s)
- Eleanor Turi
- University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104
| | - Amy L. McMenamin
- Columbia University School of Nursing, 560 W 168 Street, New York, NY, 10032
| | - Suzanne Courtwright
- Columbia University School of Nursing, 560 W 168 Street, New York, NY, 10032
| | - Grant Martsolf
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA, 15213
| | - Jianfang Liu
- Columbia University School of Nursing, 560 W 168 Street, New York, NY, 10032
| | - Deborah Hasin
- Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY, 10032
- Columbia University Mailman School of Public Health, 722 W 168 Street, New York, NY, 10032
| | - Lusine Poghosyan
- Columbia University School of Nursing, 560 W 168 Street, New York, NY, 10032
- Columbia University Mailman School of Public Health, 722 W 168 Street, New York, NY, 10032
| |
Collapse
|
2
|
Duignan M, Drennan J, Mc Carthy VJC. Work characteristics, job satisfaction and intention to leave: a cross-sectional survey of advanced nurse practitioners. Contemp Nurse 2024; 60:382-394. [PMID: 38489485 DOI: 10.1080/10376178.2024.2327353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/01/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Advanced Nurse Practitioners (ANPs) are highly skilled health care professionals with the potential to play a major role in improving the quality and accessibility of health care services. However, there is emerging evidence of disquiet among nurse practitioners who often work in suboptimal work environments. Therefore, it is important to understand the elements that contribute to ANPs' job satisfaction and retention in healthcare services. AIM To examine the effects of commitment to the workplace, work engagement, and influence at work on job satisfaction and intention to leave of ANPs. METHODS A total of 153 ANP's on the advanced practice section of the Nursing and Midwifery Board of Ireland register completed a web survey between July and August 2020. Independent variables (commitment to the workplace, work engagement, and influence at work) were measured using the Copenhagen Psychosocial Questionnaire (COPSOQ). Multivariable logistic regression models were used to investigate the association between dependent and independent variables. RESULTS Participants who reported higher levels of influence at work and higher levels of commitment to the workplace were also satisfied in their job (OR 1.05, 95% CI 1.01-1.09, p = 0.025), (OR 1.10, 95% CI 1.06-1.14, p < 0.001) respectively. Additionally, ANPs with higher levels of commitment to work were significantly less likely to leave their role (OR 0.94, 95% CI .92-.96, p < 0.001). CONCLUSION Healthcare organisations can improve job satisfaction and decrease intention to leave by creating environments in which ANPs are supported by their colleagues and supervisors, and facilitate their practice to the full extent of their capabilities.
Collapse
Affiliation(s)
- Martin Duignan
- Health Service Executive, Our Lady's Hospital, Navan, Co., Meath, Ireland
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Ireland
| | | |
Collapse
|
3
|
de Lisser R, Dietrich MS, Spetz J, Ramanujam R, Lauderdale J, Stolldorf DP. Psychological safety is associated with better work environment and lower levels of clinician burnout. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae091. [PMID: 39081721 PMCID: PMC11288325 DOI: 10.1093/haschl/qxae091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 07/05/2024] [Accepted: 07/16/2024] [Indexed: 08/02/2024]
Abstract
Burnout is attributed to negative work environments and threatens patient and clinician safety. Psychological safety is the perception that the work environment is safe for interpersonal risk-taking and may offer insight into the relationship between the work environment and burnout. In this cross-sectional analysis of survey data from 621 nurse practitioners in California, we found that one-third (34%) experienced high burnout. Four factors in the work environment were negatively associated with burnout and positively associated with psychological safety. Significant mediation effects of psychological safety were observed on the relationships between each work environment factor and both emotional exhaustion and depersonalization. The largest mediation effects were observed on the total effects of Nurse Practitioner-Physician Relations and Practice Visibility on Emotional Exhaustion (37% and 32%, respectively) and Independent Practice and Support and NP-Administration Relations on Depersonalization (32% and 29%, respectively). We found, overall, that psychological safety decreased the strength of the negative relationship between work environment and burnout. We argue that research, practice, and policy efforts to mitigate burnout and improve the work environment should consider psychological safety as a metric for system-level well-being.
Collapse
Affiliation(s)
- Rosalind de Lisser
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
- School of Nursing, University of California San Francisco, San Francisco, CA 94143, United States
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Joanne Spetz
- Philip R. Lee Institute for Policy, University of California San Francisco, San Francisco, CA 94158, United States
| | - Rangaraj Ramanujam
- Owen Graduate School of Management, Vanderbilt University, Nashville, TN 37203, United States
| | - Jana Lauderdale
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
| | - Deonni P Stolldorf
- School of Nursing, Vanderbilt University, Nashville, TN 37240, United States
| |
Collapse
|
4
|
Aronowitz T, Peterson KS, Morris NS. Moving the Disparity Needle: Resourcing Care Delivery for Those With Greatest Needs. Med Care 2024; 62:213-216. [PMID: 38315884 DOI: 10.1097/mlr.0000000000001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Teri Aronowitz
- Department of Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA
| | | | | |
Collapse
|
5
|
Poghosyan L, Liu J, Turi E, Flandrick K, Robinson M, George M, Martsolf G, Carthon JMB, O'Reilly-Jacob M. Racial and ethnic disparities in ED use among older adults with asthma and primary care nurse practitioner work environments. RESEARCH SQUARE 2024:rs.3.rs-3972673. [PMID: 38559202 PMCID: PMC10980142 DOI: 10.21203/rs.3.rs-3972673/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Nurse practitioners (NPs) increasingly deliver primary care in the United States. Yet, poor working conditions strain NP care. We examined whether racial/ethnic health disparities in ED visits among older adults with asthma are moderated by primary care NP work environments. Methods Survey data on NP work environments in six states were collected from 1,244 NPs in 2018-2019. 2018 Medicare claims data from 46,658 patients with asthma was merged with survey data to assess the associations of all-cause and ambulatory care sensitive conditions (ACSC) ED visits with NP work environment and race/ethnicity using logistic regression. Results NP work environment moderated the association of race (Black patients versus White patients) with all-cause (odds ratio [OR]: 0.91; p-value = 0.045) and ACSC (OR: 0.90; p-value = 0.033) ED visits. Conclusions Disparities in ED visits between Black and White patients with asthma decrease when these patients receive care in care clinics with favorable NP work environments.
Collapse
Affiliation(s)
| | | | - Eleanor Turi
- Perelman School of Medicine, University of Pennsylvania
| | | | | | | | | | | | | |
Collapse
|
6
|
Marshall AL, Masselink LE, Kouides PA, Davies FE, Farooqui A, Nagalla S, Herrera A, Mortier N, Brodsky R, Erikson CE. Advanced practice providers in hematology: actionable findings from national paired APP and physician surveys. Blood Adv 2024; 8:1179-1189. [PMID: 38127271 PMCID: PMC10910059 DOI: 10.1182/bloodadvances.2023011927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
ABSTRACT Advanced practice providers (APPs) are critical to the hematology workforce. However, there is limited knowledge about APPs in hematology regarding specialty-specific training, scope of practice, challenges and opportunities in APP-physician interactions, and involvement with the American Society of Hematology (ASH). We conducted APP and physician focus groups to elucidate major themes in these areas and used results to inform development of 2 national surveys, 1 for APPs and 1 for physicians who work with APPs. The APP survey was distributed to members of the Advanced Practitioner Society of Hematology and Oncology, and the physician survey was distributed to physician members of ASH. A total of 841 APPs and 1334 physicians completed the surveys. APPs reported most hematology-specific knowledge was obtained via on-the-job training and felt additional APP-focused training would be helpful (as did physicians). Nearly all APPs and physicians agreed that APPs were an integral part of their organizations and that physician-APP collaborations were generally positive. A total of 42.1% of APPs and 29.3% of physicians reported burnout, and >50% of physicians felt that working with APPs had reduced their burnout. Both physicians and APPs reported interest in additional resources including "best practice" guidelines for APP-physician collaboration, APP access to hematology educational resources (both existing and newly developed resources for physicians and trainees), and greater APP integration into national specialty-specific professional organizations including APP-focused sessions at conferences. Professional organizations such as ASH are well positioned to address these areas.
Collapse
Affiliation(s)
- Ariela L. Marshall
- Division of Hematology Oncology and Transplantation, University of Minnesota, Minneapolis, MN
| | - Leah E. Masselink
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| | | | - Faith E. Davies
- Pearlmutter Cancer Center, New York University Langone Health, New York, NY
| | - Azam Farooqui
- Department of Hematology and Oncology, Ironwood Cancer & Research Centers, Chandler, AZ
| | | | - Alex Herrera
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, Duarte, CA
| | - Nicole Mortier
- Sickle Cell Disease Clinical Trials Network, ASH Research Collaborative, Washington, DC
| | - Robert Brodsky
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clese E. Erikson
- Fitzhugh Mullan Institute for Health Workforce Equity, The George Washington University, Washington, DC
- Department of Health Policy and Management, George Washington University Milken Institute School of Public Health, Washington, DC
| |
Collapse
|
7
|
Turi E, McMenamin AL, Martsolf G, Hasin D, Han BH, Liu J, Poghosyan L. Primary care nurse practitioner work environments and emergency department utilization among older adults with substance use disorders in rural areas. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209285. [PMID: 38159910 PMCID: PMC10922346 DOI: 10.1016/j.josat.2023.209285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The prevalence of substance use disorders (SUDs) is growing among older adults, and older adults in rural areas face disparities in access to SUD care. Rural older adults with SUDs commonly have comorbid chronic conditions that puts them at risk for frequent acute healthcare utilization. In rural areas, primary care for patients with SUDs are increasingly provided by nurse practitioners (NPs), and quality primary care services may decrease ED visits in this population. Yet, NP-delivered primary care for rural older adults with SUDs may be limited by work environment barriers, which include lack of support, autonomy, and visibility. This study assessed the relationship between the NP work environment and ED utilization among rural older adults with SUDs. METHODS This was a secondary analysis of cross-sectional data from a large survey of NPs in six U.S. states merged with Medicare claims. The study measured the NP work environment by the four subscales of the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), which measure 1) independent practice and support, 2) NP-physician relations, 3) NP-administration, and 4) professional visibility. Multilevel logistic regression models, adjusted for practice and patient covariates, assess the relationship between the NP work environment and all-cause ED use. RESULTS The sample included 1152 older adults with SUDs who received care at 126 rural NP primary care practices. NP independent practice and support at the practice was associated with 49 % lower odds of all-cause ED visits among older adults with SUDs. There were no relationships between the other NP-PCOCQ subscales and all-cause ED visits. CONCLUSIONS Organizational support for NP independent practice is associated with lower odds of all-cause ED utilization among rural older adults with SUDs. Practice administrators should ensure that NPs have access to support and resources to enhance their ability to care for rural older adults with SUDs. Ultimately, these practice changes could reduce ED utilization and health disparities in this population.
Collapse
Affiliation(s)
- Eleanor Turi
- University of Pennsylvania Perelman School of Medicine, 423 Guardian Drive, Philadelphia, PA 19104, United States of America.
| | - Amy L McMenamin
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America
| | - Grant Martsolf
- University of Pittsburgh School of Nursing, 3500 Victoria Street, Pittsburgh, PA 15213, United States of America
| | - Deborah Hasin
- Columbia University Department of Psychiatry, 1051 Riverside Drive, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America
| | - Benjamin H Han
- University of California San Diego Department of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, United States of America
| | - Jianfang Liu
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America
| | - Lusine Poghosyan
- Columbia University School of Nursing, 560 West 168th Street, New York, NY 10032, United States of America; Columbia University Mailman School of Public Health; 722 West 168th Street, New York, NY 10032, United States of America
| |
Collapse
|
8
|
Poghosyan L, Courtwright S, Flandrick KR, Pollifrone MM, Schlak A, O'Reilly-Jacob M, Brooks Carthon JM, Gigli KH, Porat-Dahlerbruch J, Alexander G, Brom H, Maier CB, Timmons E, Ferrara S, Martsolf GR. Advancement of research on nurse practitioners: Setting a research agenda. Nurs Outlook 2023; 71:102029. [PMID: 37619489 PMCID: PMC10810357 DOI: 10.1016/j.outlook.2023.102029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/06/2023] [Accepted: 07/17/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Primary care delivered by nurse practitioners (NPs) helps to meet the United States' growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them. PURPOSE We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce. METHODS Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions. DISCUSSION The research agenda includes top-ranked research questions within five categories: (a) policy regulations and implications for care, quality, and access; (b) systems affecting NP practice; (c) health equity and the NP workforce; (d) NP education and workforce dynamics, and (e) international perspectives. CONCLUSION The agenda can advance evidence on the NP workforce to guide policy and practice.
Collapse
Affiliation(s)
| | | | | | | | - Amelia Schlak
- Office of Research and Development, Department of Veteran Affairs, Washington DC, WA
| | | | | | - Kristin Hittle Gigli
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Heather Brom
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, PA
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
| | - Edward Timmons
- John Chambers College of Business and Economics, West Virginia University, Morgantown, WV
| | | | | |
Collapse
|
9
|
Martsolf G, Turi E, Liu J, Chen J, Poghosyan L. DNP preparation of primary care nurse practitioners and clinical outcomes for patients with chronic conditions. Nurs Outlook 2023; 71:101951. [PMID: 36947974 PMCID: PMC10683711 DOI: 10.1016/j.outlook.2023.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Many professional nursing organizations have proposed that the Doctor of Nursing Practice (DNP) is the most appropriate entry-level degree for nurse practitioners (NPs). There have been no studies to date examining the impact of DNP preparation on quality of care or patient outcomes. PURPOSE To examine differences in emergency department utilization and hospitalizations among patients with chronic conditions cared for by Master of Science in Nursing (MSN)- and DNP-prepared primary care NPs. METHODS We use survey data from over 1,000 primary care NPs in 6 states linked to Medicare claims data. Using regression models, we controlled for various patient, NP, and practice characteristics that might confound the relationship. RESULS We find that patient outcomes are not statistically different between patients attributed to MSN- and DNP-prepared primary care NPs. DISCUSSION These findings suggest that there remains little evidence that DNP education has led to significant improvements in patient outcomes. CONCLUSIONS Further empirical analysis related to the clinical outcomes other than health care utilization of the DNP degree is warranted. Future studies might consider examining (a) NPs in settings other than primary care, (b) practice-wide or system-wide outcomes, (c) other measures of care quality, and (d) impact of DNP program content.
Collapse
Affiliation(s)
- Grant Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA.
| | - Eleanor Turi
- School of Nursing, Columbia University, New York, NY
| | - Jianfang Liu
- School of Nursing, Columbia University, New York, NY
| | - Julius Chen
- Mailman School of Public Health, Columbia University, New York, NY
| | - Lusine Poghosyan
- School of Nursing, Columbia University, New York, NY; Mailman School of Public Health, Columbia University, New York, NY
| |
Collapse
|
10
|
Tetzlaff ED, Hylton HM, Ruth KJ, Hasse Z, Hall MJ. Moral Distress, Organizational Climate, and the Risk of Burnout Among Physician Assistants in Oncology. JCO Oncol Pract 2023; 19:e639-e649. [PMID: 36780593 PMCID: PMC10414748 DOI: 10.1200/op.22.00641] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 02/15/2023] Open
Abstract
PURPOSE Moral distress (MD) is the result of barriers or constraints that prevent providers from carrying out what they believe to be ethically appropriate care. This study was initiated to explore associations between MD, burnout, and the organizational climate (OC) for oncology physician assistants (PAs). METHODS A national survey of oncology PAs was conducted to explore the associations between MD, OC, and burnout. The Nurse Practitioner-Primary Care OC Questionnaire was revised for oncology PAs to assess OC for PA practice. MD and burnout were assessed using the Measure of MD-Healthcare Professionals (MMD-HP) and the Maslach Burnout Inventory. RESULTS One hundred forty-six oncology PAs are included in the analysis. PAs were mostly female (90%), White/Caucasian (84%), married/partnered (78%), and in medical oncology (73%), with mean age 41.0 years. The mean MMD-HP score for oncology PAs was 71.5 and there was no difference in MD scores on the basis of oncology subspecialty, practice setting, practice type, or hours worked per week. PAs currently considering leaving their position because of MD had significantly higher mean scores on the MMD-HP compared with those not considering leaving their position (108.2 v 64.8; P = .001). PAs with burnout also had significantly higher mean scores for MD compared with PAs without burnout (97.6 v 54.3; P < .001). A negative relationship between OC for PA practice and MD was only found for the PA-administration relations subscale, whereas all subscales were negatively associated with burnout. CONCLUSION This study demonstrates that the risk of professional burnout increases significantly with increasing levels of MD. Additional research exploring the relationship between MD and burnout is needed.
Collapse
Affiliation(s)
| | - Heather M. Hylton
- Association of Physician Assistants in Oncology, Altamonte Springs, FL
| | | | | | | |
Collapse
|
11
|
Nurse practitioner integration: Conceptual development to enhance application in policy and research. J Am Assoc Nurse Pract 2022; 34:1106-1115. [PMID: 35900920 DOI: 10.1097/jxx.0000000000000761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nurse practitioners (NPs) have been introduced across the world to improve care quality and solve provider shortages. Realizing these benefits relies on their successful integration into health care systems. Although NP integration has been discussed extensively, the concept is defined inconsistently. Literature, therefore, cannot be synthesized to create policy recommendations for management and policymakers to plan for and advance NP integration. OBJECTIVES To describe and define NP integration and enhance its applicability in research and policy. DATA SOURCES A modified Walker and Avant concept analysis was used to develop a conceptual model of NP integration. Data were extracted and synthesized from 78 sources referencing the concept. CONCLUSIONS Nurse practitioner integration was operationally defined as the multilevel process of incorporating NPs into the health care system so that NPs can practice to their full scope, education, and training and contribute to patient, system, and population needs. The attributes of NP integration are: 1) achievable goal; 2) process; 3) introduction of the role; 4) incorporation into organizational care models; 5) challenging traditional ideologies; 6) ability to function; 7) provide high-quality care; and 8) improve outcomes, sustainability, and health system transformation. Seventeen facilitators/barriers affecting NP integration were identified. Three health care system levels at which integration occurs were identified- macro , meso , and micro . IMPLICATIONS FOR PRACTICE Findings will inform managers, policymakers, and stakeholders about NP integration to aid in planning and policy development. Results can be used to inform research on barriers and facilitators to NP integration.
Collapse
|
12
|
Poghosyan L, Kueakomoldej S, Liu J, Martsolf G. Advanced practice nurse work environments and job satisfaction and intent to leave: Six-state cross sectional and observational study. J Adv Nurs 2022; 78:2460-2471. [PMID: 35174905 PMCID: PMC9283202 DOI: 10.1111/jan.15176] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 11/10/2021] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
AIMS To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. DESIGN The study used a cross-sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. METHODS We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018-2019. The work environment was measured using the Nurse Practitioner-Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner-Administration Relations, Nurse Practitioner-Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed-effect proportional-odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. RESULTS Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one-unit increase in the organizational-level Nurse Practitioner-Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational-level Nurse Practitioner-Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. CONCLUSION Improvements in work environments may improve nurse practitioner job satisfaction and retention. IMPACT This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity.
Collapse
Affiliation(s)
- Lusine Poghosyan
- Stone Foundation and Elise D. Fish Professor of Nursing, Columbia University School of Nursing, New York, New York, USA.,Department of Health Policy and Management, Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | - Jianfang Liu
- Columbia University School of Nursing, New York, New York, USA
| | - Grant Martsolf
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
13
|
HO LH, CHANG SC, KAU K, SHIU SY, HUANG SS, WANG YJ, TSAY SL. The Impact of Organizational Support on Practice Outcomes in Nurse Practitioners in Taiwan. J Nurs Res 2021; 29:e148. [PMID: 33756519 PMCID: PMC8126501 DOI: 10.1097/jnr.0000000000000425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Nurse practitioners (NPs) in Taiwan have practiced mainly in acute care hospitals since 2006. Although organizational support and level of support have been associated with the successful integration of NP roles and effective practice outcomes, organizational support in the context of NPs in inpatient settings is an area that has been rarely explored in the literature. PURPOSE The purpose of this study was to investigate the relationship between organizational support and the practice outcomes of job satisfaction, care effectiveness, and intention to leave in NPs. METHODS A national survey of 512 NPs was conducted that included a demographic characteristics datasheet, the Nurse Practitioner Primary Care Organizational Climate Questionnaire, the Misener Nurse Practitioner Job Satisfaction Scale, and the Nurse Practitioner Care Effectiveness Scale. Multiple regression analysis was applied to explore the specific factors associated with job satisfaction. The statistical significance level was set at .05 with a two-tailed test. All statistical analyses were conducted using SPSS Statistics Version 22.0 software. RESULTS More than half of the participants were found to be dissatisfied with their hospital managers (54.8%) and with each dimension of organizational support. Overall, 82.1% of the participants were satisfied with their current practice. A multiple regression analysis showed that the participants who perceived higher levels of organizational support in the workplace (β = .53, p < .001), expressed satisfaction with working with their managers (β = .25, p < .001), or perceived better care outcomes (β = .10, p < .001) reported higher job satisfaction. In addition, the participants who expressed intention to leave within 1 year (β = -.09, p < .001) and those with higher patient loads (β = -.09, p < .001) reported lower job satisfaction. Organizational support was found to explain 50% of the variance in job satisfaction. CONCLUSIONS/IMPLICATIONS FOR PRACTICE The results of this study highlight organizational support as the most important factor affecting job satisfaction in NPs. Therefore, administrators work to promote organizational support and improve the work environment to enhance the job satisfaction, increase the clinical practice retention, and improve the care outcomes of NPs.
Collapse
Affiliation(s)
- Li-Hui HO
- MS, RN, NP, Department of Neurosurgery, China Medical Hospital, Taiwan, Republic of China
| | - Shu-Chen CHANG
- PhD, RN, Director, Department of Nursing, Chunghwa Christian Hospital, and Adjunct Assistant Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan, Republic of China
| | - Kevin KAU
- MA, Lecturer, Academic Writing Education Center, National Taiwan University, Taiwan, Republic of China
| | - Shu-Ying SHIU
- MS, RN, NP, Emergency Room, Department of Nursing, Chunghwa Christian Hospital, Taiwan, Republic of China
| | - Sheng-Shiung HUANG
- PhD, Assistant Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan, Republic of China
| | - Ya-Jung WANG
- PhD, RN, Assistant Professor, Department of Nursing, Da-Yeh University, Taiwan, Republic of China
| | - Shiow-Luan TSAY
- PhD, RN, NP, Professor, College of Nursing and Health Sciences, Da-Yeh University, Taiwan, Republic of China
| |
Collapse
|
14
|
Hsiung KS, Colditz JB, McGuier EA, Switzer GE, VonVille HM, Folb BL, Kolko DJ. Measures of Organizational Culture and Climate in Primary Care: a Systematic Review. J Gen Intern Med 2021; 36:487-499. [PMID: 33140272 PMCID: PMC7878641 DOI: 10.1007/s11606-020-06262-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 09/21/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Primary care is increasingly contributing to improving the quality of patient care. This has imposed significant demands on clinicians with rising needs and limited resources. Organizational culture and climate have been found to be crucial in improving workforce well-being and hence quality of care. The objectives of this study are to identify organizational culture and climate measures used in primary care from 2008 to 2019 and evaluate their psychometric properties. METHODS Data sources include PubMed, PsycINFO, HAPI, CINAHL, and Mental Measurements Yearbook. Bibliographies of relevant articles were reviewed and a cited reference search in Scopus was performed. Eligibility criteria include primary health care professionals, primary care settings, and use of measures representing the general concept of organizational culture and climate. Consensus-Based Standards for the selection of health Measurement Instruments (COSMIN) guidelines were followed to evaluate individual studies for methodological quality, rate results of measurement properties, qualitatively pool studies by measure, and grade evidence. RESULTS Of 1745 initial studies, 42 studies met key study inclusion criteria, with 27 measures available for review (16 for organizational culture, 11 for organizational climate). There was considerable variability in measures, both conceptually and in psychometric quality. Many reported limited or no psychometric information. DISCUSSION Notable measures selected for frequent use and strength and applicability of measurement properties include the Culture Questionnaire adapted for health care settings, Practice Culture Assessment, and Medical Group Practice Culture Assessment for organizational culture. Notable climate measures include the Nurse Practitioner Primary Care Organizational Climate Questionnaire, Practice Climate Survey, and Task and Relational Climate Scale. This synthesis and appraisal of organizational culture and climate measures can help investigators make informed decisions in choosing a measure or deciding to develop a new one. In terms of limitations, ratings should be considered conservative due to adaptations of the COSMIN protocol for clinician populations. PROSPERO REGISTRATION NUMBER CRD 42019133117.
Collapse
Affiliation(s)
- Kimberly S Hsiung
- University of Pittsburgh School of Medicine, , Pittsburgh, PA, USA.
- Clinical and Translational Science Institute, University of Pittsburgh, , Pittsburgh, PA, USA.
| | - Jason B Colditz
- University of Pittsburgh School of Medicine, , Pittsburgh, PA, USA
| | | | - Galen E Switzer
- Department of Medicine, University of Pittsburgh, , Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion (CHERP), Veterans Affairs Pittsburgh Healthcare System, , Pittsburgh, PA, USA
| | - Helena M VonVille
- Health Sciences Library System, University of Pittsburgh, , Pittsburgh, PA, USA
| | - Barbara L Folb
- Health Sciences Library System, University of Pittsburgh, , Pittsburgh, PA, USA
| | - David J Kolko
- University of Pittsburgh School of Medicine, , Pittsburgh, PA, USA
- UPMC Western Psychiatric Hospital, , Pittsburgh, PA, USA
| |
Collapse
|
15
|
State policy change and organizational response: Expansion of nurse practitioner scope of practice regulations in New York State. Nurs Outlook 2020; 69:74-83. [PMID: 33268102 DOI: 10.1016/j.outlook.2020.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/23/2020] [Accepted: 08/15/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In January of 2015, New York (NY) implemented a new policy, Nurse Practitioners Modernization Act, which removed the required written practice agreement between physicians and experienced nurse practitioners (NPs). PURPOSE We examined NP work environment in NY before (2012) and after (2018) the implementation of the new policy. METHODS Cross-sectional survey data on work environments were collected from NPs in NY in 2012 and 2018. Work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire. In 2012, 278 and in 2018, 348 NPs completed the tool. Regression analyses were used to examine the relationship between the study year and work environment. FINDINGS Controlling for individual and organizational characteristics, NPs reported significantly better work environments in 2018. Positive changes were observed both for experienced and less experienced NPs. DISCUSSION Removing state-level policy restrictions on NPs may promote a better work environment within health care organizations.
Collapse
|