Dissertation

An Exploration of Nurse Practitioner Integration into the Delivery of Healthcare Services in the United States

Stevens, Lena

2022

Overview

The nurse practitioner (NP) role has emerged as a key role in primary care in the United States. NPs can help meet growing primary care needs, contribute to greater access to care for patients, and provide care that is of high quality, leads to high patient satisfaction, and is cost-effective. While many stakeholders in the fields of nursing and primary care have argued for further expanding NP scope of practice, others, predominantly medical organizations, have questioned this approach. NP practice is governed at the state level, but it is also influenced by organizational level factors, like institutional policies, which can influence the NP practice environment. Therefore, organized medicine's opposition, in combination with varying state laws and regulations, as well as organizational barriers have prevented NPs from practicing to the full extent of their education and training in many states. Thus, the overall goal of this dissertation is to provide further clarity around the integration of the NP role into the delivery of healthcare services in the United States via three specific aims. Aim 1 provides an evidence-based overview of the terms used in the existing literature to describe NP integration into primary care and determines characteristics of distinct models of care. This first aim will help reduce confusion around the labeling and operationalization of terms, it will further allow health professionals to work towards common goals, and it will provide a foundation for future outcomes research around NP-physician models of care. Aim 2 examines why some states have achieved full NP scope of practice authority while others have not. This second aim can help guide state policy makers and NP professional organizations in their lobbying efforts and decision making around future NP policy efforts. Further, understanding why some states have achieved full scope of practice authority while others have not is critical as NPs working in full scope of practice states have reported more favorable work environments and, if utilized effectively, NPs can be considered part of the solution to the primary care physician shortage. Aim 3 provides specific recommendations for administrators that will improve the NP-administrator relationship in primary care practices. This third aim can help create more favorable NP practice environments, which are essential for NPs to succeed in their work.

• Publisher: ProQuest Dissertations & Theses
• Subject: American studies / Health care / Health care management / Nursing / Public health
• ISBN: 9798371909145