Columbia University School of Nursing, 617 W. 168th Street, GB 219, New York, NY 10032, United States.
Columbia University School of Nursing, 617 W. 168th Street, GB 245, New York, NY 10032, United States.
Int J Nurs Stud. 2017 Sep;74:1-7. doi: 10.1016/j.ijnurstu.2017.05.004. Epub 2017 May 25.
Health care systems globally are facing challenges of meeting the growing demand for primary care services due to a shortage of primary care physicians. Policy makers and administrators are searching for solutions to increase the primary care capacity. The effective utilization of nurse practitioners (NPs) has been proposed as a solution. However, organizations utilize NPs in variable capacities. In some settings, NPs serve as primary care providers delivering ongoing continuous care to their patients, referred to as patient panels, whereas in other settings they deliver episodic care. Little is known about why organizations deploy NPs differently.
Investigate the NP role in care delivery-primary care providers with the own patient panels or delivering episodic care-within their organizations and understand how work environments affect their role.
A cross-sectional survey design was used to collect data from primary care NPs.
The study was conducted in one state in the United States (Massachusetts). Data from 163 primary care organizations was obtained, which employed between one to 12 NPs.
807 NPs recruited from the Massachusetts Provider Database received mail surveys; 314 completed and returned the survey, yielding a response rate of 40%.
The survey contained measures of NP role in care delivery and work environment. NP role was measured by an item asking NPs to report if they deliver ongoing continuous care to their patient panel or if they do not have patient panel. The work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). The multilevel Cox regression models investigated the influence of organization-level work environment on NP role in care delivery.
About 45% of NPs served as primary care providers with their own patient panel. Organization-level Independent Practice and Support subscale, an NP-PCOCQ subscale, had a significant positive effect on NP role (risk ratio=2.33; 95% CI: 1.06-5.13); with a one unit increase on this subscale, the incidence of the NPs serving as primary care providers with their own patient panel doubled.
NPs can help meet the increasing demand for primary care by taking responsibilities as primary care providers, and organizations can assign NPs their own patient panels. Supporting NP independent practice within organizations promotes NP role as primary care providers. Policy and organizational change focused on promoting NP work environments so NPs can practice as primary care providers can be an effective strategy to increase the primary care capacity.
由于初级保健医生短缺，全球各国的医疗体系都面临着满足日益增长的初级保健服务需求的挑战。政策制定者和管理人员正在寻找增加初级保健能力的解决方案。有效利用执业护士（NP）已被提议作为一种解决方案。然而，各组织对 NP 的使用方式存在差异。在一些环境中，NP 作为初级保健提供者，为其患者提供持续的连续护理，被称为患者群体，而在其他环境中，他们提供偶发性护理。对于为什么各组织对 NP 的使用方式不同，我们知之甚少。
调查 NP 在其组织内提供护理的角色——作为有自己患者群体的初级保健提供者或提供偶发性护理——并了解工作环境如何影响他们的角色。
使用横断面调查设计从初级保健 NP 中收集数据。
该研究在美国一个州（马萨诸塞州）进行。从 163 个雇用 1 至 12 名 NP 的初级保健组织中获得数据。
从马萨诸塞州提供者数据库中招募的 807 名 NP 收到了邮件调查；314 名完成并返回了调查，回应率为 40%。
调查包含 NP 在护理提供中的角色和工作环境的测量。NP 角色通过询问 NP 是否为其患者群体提供持续的连续护理或是否没有患者群体来衡量。工作环境使用执业护士初级保健组织气候问卷（NP-PCOCQ）进行衡量。多水平 Cox 回归模型调查了组织层面工作环境对 NP 在护理提供中的角色的影响。
约 45%的 NP 担任有自己患者群体的初级保健提供者。组织层面的独立实践和支持子量表（NP-PCOCQ 的一个子量表）对 NP 角色有显著的积极影响（风险比=2.33；95%CI：1.06-5.13）；该子量表增加一个单位，NP 作为有自己患者群体的初级保健提供者的发生率增加一倍。
NP 可以通过承担初级保健提供者的责任来帮助满足对初级保健日益增长的需求，并且组织可以为 NP 分配自己的患者群体。在组织内支持 NP 的独立实践可以促进 NP 作为初级保健提供者的角色。以促进 NP 工作环境为重点的政策和组织变革，以便 NP 可以作为初级保健提供者进行实践，这可以是增加初级保健能力的有效策略。
