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Elvidge N, Hobbs M, Fox A, Currie J, Williams S, Theobald K, Rolfe M, Marshall C, Phillips JL. Practice pathways, education, and regulation influencing nurse practitioners' decision to provide primary care: a rapid scoping review. BMC PRIMARY CARE 2024; 25:182. [PMID: 38783189 PMCID: PMC11112961 DOI: 10.1186/s12875-024-02350-3] [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: 12/18/2023] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND/OBJECTIVE Initially established to improve access to healthcare, particularly for primary care, the full potential of the nurse practitioner role is yet to be realised in most countries. Despite this, most countries are working to meet an ageing population's increasing healthcare needs and reduce healthcare costs and access disparities. Achieving these outcomes requires reform at multiple levels, including nurse practitioner practice pathways, education and regulation, and identifying the barriers and facilitators to optimising their primary care role. METHODS A rapid scoping review of nurse practitioner practice pathways, education and regulation inclusive of: (1) a systematic search of Medline and CINAHL for peer-reviewed English language articles, including opinion pieces published between January 2015 and February 2022; and (2) a web-based search of nurse practitioner program entry requirements of International Nurse Regulator Collaborative country members with a protected nurse practitioner title and prescribing rights, plus the Netherlands. The individually summarised search data was integrated and synthesised using Popay's narrative approach. RESULTS Emerging evidence from the included nurse practitioner courses (n = 86) and articles (n = 79) suggests nurse practitioners working in primary care provide safe, effective care and improve healthcare efficiencies. However, different regulatory and educational models are required if the primary care nurse practitioner is to meet growing demand. CONCLUSIONS International variations in entry criteria, curriculum, and regulation shape the global profile of the nurse practitioner primary care workforce and their practice setting. For countries to grow their primary care nurse practitioner workforce to meet unmet needs, different entry requirements, program content and accredited post-registration transitional programs must be urgently considered.
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Affiliation(s)
- Norah Elvidge
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Megan Hobbs
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Amanda Fox
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Metro North Health, Redcliffe Hospital, Redcliffe, Australia
| | - Jane Currie
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Suzanne Williams
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Karen Theobald
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Melanie Rolfe
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Australia
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Claire Marshall
- Improving Palliative Care Through Clinical Trials (ImPaCCT), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jane L Phillips
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology, Brisbane, Australia.
- School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
- Improving Palliative Care Through Clinical Trials (ImPaCCT), Faculty of Health, University of Technology Sydney, Sydney, Australia.
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Bae K, Norris C, Shakya S, Timmons E. Advanced Practice Registered Nurse Full Practice Authority, Provider Supply, and Health Outcomes: A Border Analysis. Policy Polit Nurs Pract 2024; 25:6-13. [PMID: 38116640 DOI: 10.1177/15271544231212155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Due to a growing physician shortage, patients have difficulty accessing primary care. In an effort to expand access and support patient health, many states are reducing barriers for advanced practice registered nurses to provide primary care without physician collaboration. Maryland provides an interesting case study. We leverage Maryland's policy change to explore the effects of full practice authority (FPA), focusing on the number of professionals and health outcomes for patients. Employing a border county comparison between Maryland and Pennsylvania, we estimate the effect of FPA. Our analysis of health outcomes focuses on three county-level health outcomes: poor or fair health, poor mental health days, and preventable hospital stays. We find that FPA is associated with increases in the number of certified nurse midwives by 0.6 per 100,000 residents and nurse practitioners by 22.4 per 100,000 residents. We also find evidence of an association of FPA with reductions in the share of residents who report being in poor or fair health by 2.8 percentage points and poor mental health days per month by 0.354 days per person. Combined, our results provide suggestive evidence that moving to FPA improves access to care and leads to improved health outcomes for Maryland residents. Removing regulatory barriers that prevent certified nurse midwives and nurse practitioners from working to the full extent of their training may increase access to primary care and improve patient outcomes.
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Affiliation(s)
- Kihwan Bae
- The Knee Center for the Study of Occupational Regulation, Morgantown, WV, USA
- West Virginia University, Morgantown, WV, USA
| | - Conor Norris
- The Knee Center for the Study of Occupational Regulation, Morgantown, WV, USA
| | - Shishir Shakya
- Shippensburg University of Pennsylvania, Shippensburg, PA, USA
| | - Edward Timmons
- The Knee Center for the Study of Occupational Regulation, Morgantown, WV, USA
- West Virginia University, Morgantown, WV, USA
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Josiah N, Shoola H, Rodney T, Arscott J, Ndzi M, Bush AD, Wilson PR, Jacques K, Baptiste DL, Starks S. Addressing systemic racism and intergenerational transmission of anxiety using Bowenian family therapy with African American populations: A Discursive paper. J Adv Nurs 2023; 79:1714-1723. [PMID: 36825628 DOI: 10.1111/jan.15610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/23/2022] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
AIM To examine the intergenerational impact of systemic racism on mental health, depicting the evolution and patterns of anxiety symptoms and the application of the Bowenian family therapy to understand the interrelatedness and long-standing impact of intergenerational trauma in African American families. This article highlights interventions that increase awareness of and promotes physical and mental health for African American populations. DESIGN Discursive Paper. METHOD Searching literature published between 2012 and 2022 in PubMed, SCOPUS, EBSCO Host and Google Scholar, we explored factors associated with systemic racism and generational anxiety. DISCUSSION Evidence-based literature supports the application of the Bowenian family therapy theoretical framework to understand the intergenerational impact of systemic racism and to address the transmission of anxiety symptoms in African American populations. CONCLUSION Culturally appropriate interventions are needed to decrease anxiety symptoms in an attempt to heal intergenerational trauma and to improve family dynamics in African American populations. IMPACT TO NURSING PRACTICE Nurses play an integral role in providing holistic quality patient-centred care for African American populations who have experienced racial trauma. It is critical for nurses to implement culturally responsive and racially informed care with patients that focuses on self-awareness, health promotion, prevention and healing in efforts to address racial trauma. Application of Bowenian family therapy can aid in the reduction of both intergenerational transmission of racial trauma and generational anxiety. NO PATIENT OR PUBLIC CONTRIBUTION There was no patient or public involvement in the design or drafting of this discursive paper. The authors reviewed the literature to develop a discussion.
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Affiliation(s)
- Nia Josiah
- Columbia University School of Nursing, New York, New York, USA
| | - Hakeem Shoola
- Columbia University School of Nursing, New York, New York, USA
| | - Tamar Rodney
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Joyell Arscott
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Maureen Ndzi
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ashley D Bush
- Department of Defense, Department of Human Resources, Fort Detrick, Maryland, USA
| | - Patty R Wilson
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Keilah Jacques
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Shaquita Starks
- Emory Nell Hodgson Woodruff, School of Nursing, Atlanta, Georgia, USA
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Dankers-de Mari EJCM, Thijssen MCE, Van Hees SGM, Albertus J, Batenburg R, Jeurissen PPT, Van Vught AJAH. How does government policy influence the employment and training of nurse practitioners and physician assistants? A realist analysis using qualitative interviews. J Adv Nurs 2023. [PMID: 36811245 DOI: 10.1111/jan.15607] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
AIMS The aim of this study was to develop insights into how and why Dutch government policies on deployment and training of nurse practitioners and physician assistants have effect and under what circumstances. DESIGN A realist analysis using qualitative interviews. METHODS Data analysis of 50 semi-structured interviews conducted in 2019 with healthcare providers, sectoral and professional associations, and training coordinators. Stratified purposive and snowball sampling were used. RESULTS Policies stimulated employment and training of nurse practitioners and physician assistants by: (1) contributing to the familiarity of participants in the decision-making process in healthcare providers with and medical doctors' trust in these professions; (2) contributing to participants' motivation in employment and training; and (3) eliminating barriers perceived by medical doctors, managers and directors. The extent to which policies affected employment and training was largely determined by sectoral and organizational circumstances, such as healthcare demand and complexity, and decision-makers in healthcare providers (medical doctors or managers/directors). CONCLUSION Effectuating familiarity and trust among participants in the decision-making process is a crucial first step. Next, policymakers can motivate participants and lower their perceived barriers by extending the scope of practice, creating reimbursement opportunities and contributing to training costs. Theoretical insights into nurse practitioner and physician assistant employment and training have been refined. IMPACT The findings highlight how governments, health insurers, sectoral and professional associations, departments, councils, healthcare providers and professionals can facilitate and support nurse practitioner and physician assistant employment and training by contributing to familiarity, trust and motivation, and by clearing perceived barriers.
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Affiliation(s)
- Ellen J C M Dankers-de Mari
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands.,Advisory Committee on Medical Manpower Planning, Capaciteitsorgaan, Utrecht, The Netherlands
| | - Marjolein C E Thijssen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands.,HAN University of Applied Sciences, Nijmegen, The Netherlands.,Radboud Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suzanne G M Van Hees
- HAN University of Applied Sciences, Nijmegen, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tilburg, The Netherlands
| | - Job Albertus
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands.,Department of Sociology, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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Plemmons A, Shakya S, Cato K, Sadarangani T, Poghosyan L, Timmons E. Exploring the Relationship between Nurse Practitioner Full Practice Authority, Nurse Practitioner Workforce Diversity, and Disparate Primary Care Access. Policy Polit Nurs Pract 2023; 24:26-35. [PMID: 36482692 DOI: 10.1177/15271544221138047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this study, we examine how full nurse practitioner (NP) practice authority affects racial and ethnic diversity of the NP workforce. Specifically, the purpose of our research is to understand the relationship between the racial and ethnic composition of the NP workforce, NP level of practice authority, and the communities they service. In this paper, we compare the ethnic and racial composition of the NP workforce to the composition of the state's population, and then observe if there are any noticeable differences in the patients served by NPs when we compare full practice authority (FPA) and non-FPA states. We also estimate how FPA affects the race and ethnicity of Medicare patients served by NPs.
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Affiliation(s)
- Alicia Plemmons
- West Virginia University John Chambers College of Business and Economics
| | | | | | | | | | - Edward Timmons
- West Virginia University John Chambers College of Business and Economics
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Martsolf GR, Kandrack R, Ferrara SA, Poghosyan L. The Impact of the New York Nurse Practitioner Modernization Act on the Employment of Nurse Practitioners in Primary Care. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231171333. [PMID: 37139742 PMCID: PMC10161305 DOI: 10.1177/00469580231171333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Expanding scope of practice (SOP) for nurse practitioners (NPs) may increase NP employment in primary care practices which can help meet the growing demand in primary care. We examined the impact of enacting less restrictive NP practice restrictions-NP Modernization Act-in New York State (NYS) on the overall employment of primary care NPs and specifically in underserved areas. We used longitudinal data from the SK&A outpatient database (2012-2018) to identify primary care practices in NYS and in the comparison states (Pennsylvania [PA] and New Jersey [NJ]). Using a difference-in-differences design with an event study specification, we compared changes in (1) the presence and (2) total counts of NPs in primary care practices in NYS and neighboring comparison states (ie, PA and NJ) before and after the policy change. The NP Modernization Act was associated with a 1.3 percentage point lower probability of a practice employing at least one NP on average across each of the 3 post-periods (95% CI: -.024, -.002). NP Modernization Act was associated with 0.065 fewer NPs on average across the post-period (95% CI: -.119, -.011). Results were similar in underserved areas. NP employment in primary care practices in NYS was lower after the NP Modernization Act than would have been expected based counterfactual of comparison states. The negative relationship may be explained by gains in provider efficiency which leads to reduced NP hiring in primary care. More research is needed to understand the relationship between SOP regulations, NP supply, and access to care.
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