Jana Zwilling

Aims: To examine whether professional quality of life, team cohesion, and organizational commitment were independently associated with intent to leave among nursing personnel. Background: Prior research links professional quality of life with turnover intention, but less is known about joint associations with team cohesion and multidimensional organizational commitment in nursing workforces. Methods: A cross‐sectional electronic survey of 633 nursing personnel in North Dakota used validated measures. Pearson correlations, multiple regression, and post hoc nested regression were conducted. Results: The full model explained 47% of intent‐to‐leave variance. Burnout was positively associated with intent to leave ( β = 0.40, p < 0.001), whereas affective commitment ( β = −0.41, p < 0.001) and continuance commitment ( β = −0.10, p = 0.003) were inversely associated. Secondary traumatic stress (STS) was positively correlated with intent to leave ( r = 0.16) but negatively associated after adjustment ( β = −0.11, p = 0.005); its coefficient reversed when burnout entered. Conclusions: Intent to leave was associated with occupational strain and organizational attachment. The STS reversal is consistent with statistical suppression and should not be interpreted as protective. Implications for Nursing Management: Findings identify burnout and affective commitment as priorities for prospective strategy testing. Longitudinal research should determine whether modifying these domains reduces intent to leave or turnover.

OBJECTIVE: The aim of this study was to examine the relationship between nurse practitioner (NP) organizational climate and the implementation of full practice authority (FPA) for NPs. BACKGROUND: In 2021, Massachusetts passed FPA for NPs. Most NPs did not experience changes to their practice. It is unknown whether NP organizational climate impacts implementation of FPA. METHODS: A Web-based survey was distributed to NPs in Massachusetts. RESULTS: Response rate was 50.3% (N = 147). Practice remained unchanged for most. Organizations with more favorable climates experienced more rapid implementation of FPA, resulting in improved efficiency (P = 0.049) and timeliness (P = 0.007) of care. Nurse practitioners outside hospital systems were more likely to report favorable organizational climates and positive change to their practice after FPA. CONCLUSIONS: Organizations that facilitate implementation of FPA are likely to experience improvement in efficiency and timeliness of patient care. Nursing leadership, especially within hospital-based organizations, can help achieve these benefits by improving the organizational climate for NPs.

The primary care (PC) physician workforce has consistently been projected as requiring additional numbers to meet the needs of the U.S. The Health Resources and Service Administration (HRSA) has reported the PC nurse practitioner (NP) workforce to be 90,000 NPs more than required to meet the PC needs of the U.S. With both clinician types contributing to the PC workforce in the country, it is difficult to understand such an oversupply of NPs with continued deficit in PC physicians. The purpose of this study was to investigate results and methods used for HRSAs current PC workforce projections and compare those with the same used for Bureau of Labor Statistics (BLS) and American Association of Medical Colleges (AAMC) projections. Methods included a review of technical documents, dashboards, and published reports. Interviews with subject matter experts were also completed. Projections were found to differ significantly, as did data and assumptions. Two of the three projections modeled physicians as the sole provider of PC. An integrated model gives the most comprehensive and accurate picture of PC workforce needs. The utilization of NPs as PC providers has been demonstrated to be safe and effective, with the potential to alleviate predicted shortages, improve patient care outcomes, reduce cost, and address PC inequities. Implications include improving workforce data, creating projections that mirror clinical integration in PC, adjusting workforce preparation funding, incentivizing interprofessional collaboration in research, addressing barriers to practice among non-physician providers, and leveraging growth in the NP workforce.

Background: There is a great need for primary care across the country especially in rural and underserved areas. Nurse practitioners (NPs) are filling these access gaps by providing high-quality, cost-effective primary care. However, one rural midwestern state does not address NP workforce data separately from other types of nursing data. In addition, these data are not included in the state's overall primary care workforce. Therefore, the data cannot be compared to the state's needs or national workforce trends. Purpose: The purpose of this investigation was to describe North Dakota's (NDs) NP workforce and compare this with national data. Methods: A cross-sectional descriptive design was used to collect and analyze NP workforce data from several sources. State Board of Nursing licensure data were used for description of the NDs current NP workforce. Six other data sources or reports were used to complete the data picture. State information was then compared with national NP survey results. Results: Both ND and national data sources reported the largest percentage of NPs certified in either primary care or adult care and practice primary care at either an outpatient or inpatient setting. North Dakota has a higher percentage of NPs working in primary care as compared with the national numbers. However, inconsistent categories are used in ND's NP workforce data and national surveys making comparisons difficult. Implications for practice: Accurate inclusion of NP workforce data in the overall health care workforce data will better guide state and national policy makers on necessary changes to decrease provider shortages and promote increased access to rural primary care services.

Background and purpose: Full practice authority for nurse practitioners (NPs) is optimal for high-quality, cost-effective health care. However, a complete picture of utilization after states have adopted full practice authority needs to be determined. The purpose of this examination was to review the evidence regarding practice-level utilization (PLU) of NP PLU in comparison to state-level regulations (SLRs). Methods: Studies published in English and based on US populations were identified through PubMed, CINAHL, and Scopus (January 1, 1989–December 31, 2018), and bibliographies of retrieved articles. Of the 419 articles identified with these limits, 19 (5%) met all inclusion and exclusion criteria. Conclusions: Four categories of PLU were identified: billing practices, level of supervision, privileges, and prescriptive authority. Significant differences were seen between urban versus rural NPs and primary care versus specialty NPs. Thirteen of the 19 studies did not specifically address the SLR of the included sample. Implications for practice: No studies described the type of NP certification, practice specialty, and utilization, and compared all to the SLR. There is a need for more evidence concerning PLU of NPs across the tiers of SLR. Only then can health care organizations, political leaders, and other stakeholders have the information needed to proceed with beneficial practice-model changes.

The advanced practice registered nursing must have knowledge of and the ability to create the systems of care that will ensure the high quality and cost effective care needed in the future. Many factors are involved in understanding organizational influences that affect the advanced practice registered nurses (APRNs) roles and functions. Advanced knowledge in such fields as organizational behavior, cost analysis, risk management, patient satisfaction, safety, and quality is necessary to fully implement the role of the APRN. APRNs must develop the knowledge to analyze organizational variables and the skills and abilities to enhance quality and safety. To ensure that the APRN is on the forefront of new and innovative care delivery practices, an understanding of the healthcare systems and organizations that are and should be in place where the APRN practices is a needed prerequisite.

Guiding and supporting, as well as advocating for patients, have always been a hallmark of nursing. Nurse practitioners (NPs) advance this care to the next level. NPs have been steadily increasing in number and breaking down barriers to a full scope-of-practice. Evidence supports NPs in this role and looks for these advanced practice nurses to lead the way in formulating new and better primary care models. There have been many innovations over the past 50-plus years in the healthcare arena, none as disruptive as that of the NP. This chapter provides insight into the contributions of NPs as healthcare providers in the rural setting. It provides a brief background on NPs, discussion on access to healthcare, and looks at the unique patient-centered care provided by NPs. Training as a family NP provides the broadest scope-of-practice, highly desired by rural healthcare systems to eliminate the necessity of multiple provider types.