Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey

Abstract

BACKGROUND:The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians. OBJECTIVE: We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians. DESIGN: Using a cross-sectional survey design, data was collected from 163 p ri mary care practices in Massachusetts. PARTICIPANTS: Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %. MAIN MEASURES: The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale. KEY RESULTS: The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model. CONCLUSION: The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.

An inductive qualitative approach to explore Nurse Practitioners views on leadership and research: An international perspective

“…An autonomous nurse practitioner practices with a nursing philosophy and without being dependent upon medicine (Weiland, ). Recent literature reports that NPs working independently of physician oversight had greater autonomy associated with greater job satisfaction (Petersen & Way, ; Poghosyan & Liu, ; Spetz, Skillman, & Andrilla, ). This research concurs that NPs in both Ireland and Australia are independent and autonomous in their clinical work, and it is important to note that participants were primarily working in the acute hospital environment and regulation in Ireland and Australia require collaborative agreements with an identified physician.…”

Understanding the autonomy–meaningful work relationship in nursing: A theoretical framework

“…Several studies have found a positive relationship between higher levels of professional nurse autonomy and higher levels of team work (i.e., nurses' working relationships with others) (Poghosyan & Liu 2016;Rafferty, Ball, & Aiken, 2001). Team working may be most effective when the staff involved have professional autonomy as they feel their practice is not restricted.…”

Transformational leadership to promote nurse practitioner practice in primary care

“…For example, leaders within health care organisations such as practice managers or medical directors do not share information with NPs to support their care delivery or take NPs' concerns seriously (Poghosyan, Nannini, Stone, et al, 2013). Such poor organisational attributes and relationships between NPs and administrators not only negatively impact the practice of NPs but also undermine teamwork between NPs and physicians (Poghosyan & Liu, 2016).…”