{"title":"Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas","authors":"Margo Brooks Carthon PhD, APRN, FAAN, Heather Brom PhD, NP-C, Jacqueline Nikpour PhD, RN, Barbara Todd DNP, CRNP, FAANP, Linda Aiken PhD, FAAN, Lusine Poghosyan PhD, MPH, RN, FAAN","doi":"10.1016/S2155-8256(22)00028-X","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive </span>scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities.</p></div><div><h3>Purpose</h3><p>The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs.</p></div><div><h3>Methods</h3><p>This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource<span> Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics.</span></p></div><div><h3>Results</h3><p>Among all included NPs, 95.7% rated their practice as having “excellent,” “very good,” or “good” quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89).</p></div><div><h3>Conclusion</h3><p>Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.</p></div>","PeriodicalId":46153,"journal":{"name":"Journal of Nursing Regulation","volume":"13 1","pages":"Pages 5-12"},"PeriodicalIF":4.2000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"9","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Nursing Regulation","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S215582562200028X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 9
Abstract
Background
Deployment of nurse practitioners (NPs) to health professional shortage areas (HPSA) may help to address challenges in patient access to care. However, restrictive scope of practice imposed by regulatory and state legislative bodies or unsupportive organizational climates in clinical practice settings may constrain NP care delivery and perpetuate lower assessments of quality of care provided in these underserved communities.
Purpose
The purpose of this study was to investigate the associations between state NP scope of practice regulations, NP practice environment, and self-reported ratings of quality of care in primary care practices located in HPSAs.
Methods
This was a cross-sectional analysis of data from 1,972 participant NPs practicing across 1,711 primary care practices in six states representing full (Arizona and Washington), reduced (Pennsylvania and New Jersey), and restricted (California and Florida) NP scope of practice regulation. Survey data were merged with the Area Health Resource Files to determine practices located in primary care HPSAs. Logistic regression models estimated the relationship between quality ratings, scope of practice regulations, and practice environment scores while accounting for NP and practice characteristics.
Results
Among all included NPs, 95.7% rated their practice as having “excellent,” “very good,” or “good” quality of care. Practice environments with higher scores had higher ratings of quality of care after accounting for NP and practice characteristics (OR = 3.73, 95% CI: 2.84, 4.89).
Conclusion
Unsupportive clinical practice environments were associated with lower ratings of quality of care in HPSAs, suggesting that improvements in working conditions may be necessary adjuncts to greater deployment of NPs to improve primary care in shortage areas.
期刊介绍:
Journal of Nursing Regulation (JNR), the official journal of the National Council of State Boards of Nursing (NCSBN®), is a quarterly, peer-reviewed, academic and professional journal. It publishes scholarly articles that advance the science of nursing regulation, promote the mission and vision of NCSBN, and enhance communication and collaboration among nurse regulators, educators, practitioners, and the scientific community. The journal supports evidence-based regulation, addresses issues related to patient safety, and highlights current nursing regulatory issues, programs, and projects in both the United States and the international community. In publishing JNR, NCSBN''s goal is to develop and share knowledge related to nursing and other healthcare regulation across continents and to promote a greater awareness of regulatory issues among all nurses.