Chumbler N R, Geller J M, Weier A W
North Florida/South Georgia Veterans Health System and the University of Florida, Gainesville 32610-0177, USA.
Eval Health Prof. 2000 Sep;23(3):284-305. doi: 10.1177/01632780022034615.
The degree of clinical decision making and clinical productivity among nurse practitioners (NPs) is of great interest to policy makers and planners involved in providing appropriate outpatient primary care services. The authors performed a statewide mailed survey of all NPs practicing either full-time or part-time in Wisconsin (response rate of 72.1%) to address the following research questions: Do the demographic characteristics, practice attributes, and primary practice settings of NPs impact their level of clinical decision making (e.g., the autonomy to order laboratory and radiological tests or to refer a patient to a physician specialist other than their collaborating physician)? Do NPs' levels of clinical decision making correlate with their outpatient clinical productivity, adjusting for demographic characteristics, practice attributes, and primary practice settings? The multiple linear regression results indicated that having more years in practice as an NP, practicing in the family specialty area (vs. a combined other category, which included pediatrics, acute care, geriatrics, neonatal, and school), treating patients according to clinical guidelines, practicing in settings with a fewer number of physicians, and practicing in a multispecialty group practice versus a single-specialty group practice were associated with greater levels of clinical decision making. However, NPs who primarily practiced in a hospital/facility-based practice, as compared with a single-specialty group practice, had lower levels of clinical decision making. After adjusting for demographic characteristics, practice attributes, and primary practice settings, NPs with greater clinical decision-making authority had greater outpatient clinical productivity. The conclusions discuss the policy implications of the findings.
对于参与提供适当门诊初级护理服务的政策制定者和规划者而言，执业护士（NP）的临床决策程度和临床工作效率极具吸引力。作者对威斯康星州所有全职或兼职执业的NP进行了全州范围的邮寄调查（回复率为72.1%），以解决以下研究问题：NP的人口统计学特征、执业属性和主要执业环境是否会影响其临床决策水平（例如，开具实验室和放射检查的自主权，或将患者转介给与其合作医生以外的专科医生的自主权）？在调整了人口统计学特征、执业属性和主要执业环境后，NP的临床决策水平与其门诊临床工作效率是否相关？多元线性回归结果表明，作为NP执业年限更长、在家庭专科领域执业（相对于包括儿科、急性护理、老年医学、新生儿和学校在内的其他综合类别）、按照临床指南治疗患者、在医生数量较少的环境中执业，以及在多专科团体执业而非单专科团体执业，均与更高水平的临床决策相关。然而与单专科团体执业相比，主要在医院/机构执业的NP临床决策水平较低。在调整了人口统计学特征、执业属性和主要执业环境后具有更大临床决策权限 的NP门诊临床工作效率更高。结论部分讨论了研究结果的政策含义。
