Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study

Poghosyan, Lusine; Liu, Jianfang; Norful, Allison A.

doi:10.1016/j.ijnurstu.2017.05.004

Cited by 59 publications

(57 citation statements)

References 48 publications

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“…While our research shows that nurse practitioners care for patients with complex needs, our study does not provide information on the functions of nurse practitioners in care teams. 25 , 37 In prior surveys of nurse practitioners, ~40%–65%, reported having their own patient panel 28 , 29 , 33 which suggests that many nurse practitioners may independently provide care for complex patients. Nurse practitioners and physicians may also jointly manage patients such that they each uniquely contribute to patients’ care and collaboratively share responsibilities based on patient needs and provider expertise.…”

Section: Discussionmentioning

confidence: 99%

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

et al. 2020

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Objective: The objective of this study was to estimate trends in the percentage of Medicare beneficiaries cared for by nurse practitioners from 2012 to 2017, to characterize beneficiaries cared for by nurse practitioners in 2017, and to examine how the percentage of beneficiaries cared for by nurse practitioners varies by practice characteristics. Design: An observational study of 2012–2017 Medicare fee-for-service beneficiaries’ ambulatory visits. We computed the percentage of beneficiaries with 1 or more ambulatory visits from nurse practitioners and the percentage of beneficiaries receiving the plurality of their ambulatory visits from a nurse practitioner versus a physician (ie, predominant provider). We compared beneficiary demographics, clinical characteristics, and utilization by the predominant provider. We then characterized the predominant provider by practice characteristics. Key Results: In 2017, 28.9% of beneficiaries received any care from a nurse practitioner and 8.0% utilized nurse practitioners as their predominant provider—an increase from 4.4% in 2012. Among beneficiaries cared for by nurse practitioners in 2017, 25.9% had 3 or more chronic conditions compared with 20.8% of those cared for by physicians. Beneficiaries cared for in practices owned by health systems were more likely to have a nurse practitioner as their predominant provider compared with those attending practices that were independently owned (9.3% vs. 7.0%). Conclusions: Nurse practitioners are caring for Medicare beneficiaries with complex needs at rates that match or exceed their physician colleagues. The growing role of nurse practitioners, especially in health care systems, warrants attention as organizations embark on payment and delivery reform.

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Section: Discussionmentioning

confidence: 99%

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

et al. 2020

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“…The organisational climate measure used in this study has been extensively used in primary care CNPs, but not hospital‐based CNPs, nor in CRNAs (i.e. Poghosyan, Liu, & Norful, 2017; Poghosyan et al, 2014). CNP organisational climate scores in this study were somewhat lower than those reported in primary care CNPs in all domains except physician relations (Poghosyan et al, 2014, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…Poghosyan, Liu, & Norful, 2017; Poghosyan et al, 2014). CNP organisational climate scores in this study were somewhat lower than those reported in primary care CNPs in all domains except physician relations (Poghosyan et al, 2014, 2017). Lower scores in hospital‐based CNPs may be the result of the more bureaucratic, hierarchical power structures in hospital settings, where centralized power and decision‐making limit APRN participation at executive levels (McGibbon, Peter, & Gallop, 2010).…”

Section: Discussionmentioning

confidence: 99%

Advanced practice registered nurses' work environment perceptions in hospitals: A cross‐sectional survey

Schirle

Dietrich

2020

J Nurs Manag

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Aim:To examine work environment differences between hospital certified nurse practitioners (CNPs) and certified registered nurse anaesthetists (CRNAs).Background: Nurse work environments impact patient and nurse outcomes. How differing advanced practice nurse (APRN) roles influence work environments is unknown. Methods: Multi-level cross-sectional survey design. APRNs (n = 490) completed the APRN Organizational Climate Questionnaire and Psychological Ownership Questionnaire. Nurse executives (N = 24) reported on Scope of Practice and Institutional Voice. Descriptive, t test, chi-square and linear and mixed-effects regression statistical analyses were employed.Results: CNPs reported better organisational climate and job ownership than CRNAs.The largest effects involved relationships with physicians, control over practice and independent practice. Among CNPs, a significant positive relationship was observed between relations with physicians and work engagement. In CRNAs, a similar positive relationship between physician relations and work engagement was only observed for those working in higher scope of practice settings, not for those working in more restrictive settings.Conclusions: Significant differences exist in the perceived work environments between CNPs and CRNAs that may be related to differences in job design and historical relations with physician colleagues. Implications for Nursing Management: Efforts to improve APRN work environmentsin hospital settings should consider differing CRNA and CNP perspectives. K E Y W O R D Sadvanced practice nurse, APRN scope of practice, nurse anaesthetist, nurse practitioner, nurse-physician relations, work environment

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“…Nurse practitioners can autonomously evaluate, diagnose, and treat patients for chronic or acute conditions as well as provide advanced nursing care to best meet patient healthcare needs according to the regulated scope of practice in their jurisdiction 53,54. Teams with and without nurse practitioners were identified in our study because the province of Québec Canada planned to implement 2000 nurse practitioners by 2024 to improve care quality and access to care 55…”

Section: Methodsmentioning

confidence: 99%

<p>Team Functioning And Beliefs About Team Effectiveness In Inter-Professional Teams: Questionnaire Development And Validation</p>

Kilpatrick¹,

Paquette²,

Bird³

et al. 2019

JMDH

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PurposeFew validated instruments are available to measure team functioning in acute and primary care teams. To address this, we developed a questionnaire measuring healthcare provider perceptions of team effectiveness (Provider-PTE) and assessed its psychometric properties.Patients and methodsEmpirical evidence and a conceptual model were used for item generation. The 41-item self-completed questionnaire was developed. A cross-sectional survey of healthcare providers (n=283) across a range of settings was performed. Psychometric properties were assessed for French and English language questionnaires using Cronbach alpha (α) for reliability, the feedback form for face validity, expert opinion for content validity, and the known-group technique for construct validity. Responsiveness was examined by comparing scores in high and low functioning teams.ResultsThe mean time needed to complete the questionnaire was less than 9 mins. Respondents were typically female (84%), and employed full time (80%) in urban settings (82%). Cronbach α values were as follows: Team Processes = 0.88; PTE-Overall = 0.91; Outcomes = 0.72. Significant differences were found by professional group (p = 0.017), length of time in the team (p = 0.025), and presence of nurse practitioners. Responses to Outcomes varied by employment status (p = 0.017). Differences were identified in high and low functioning teams (p<0.001). Feedback indicated that two questions related to team meetings needed to be added.ConclusionThe study produced evidence of validity for English and French language Provider-PTE questionnaires. The revised 43-item instrument represents an important contribution by providing a validated questionnaire to measure team functioning across a range of settings that is consistent with a conceptual framework.

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Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study

Cited by 59 publications

References 48 publications

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

Role of Nurse Practitioners in Caring for Patients With Complex Health Needs

Advanced practice registered nurses' work environment perceptions in hospitals: A cross‐sectional survey

<p>Team Functioning And Beliefs About Team Effectiveness In Inter-Professional Teams: Questionnaire Development And Validation</p>

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