Cimiotti Jeannie P, Li Yin, Sloane Douglas M, Barnes Hilary, Brom Heather M, Aiken Linda H
Nell Hodgson Woodruff School of Nursing, Emory University.
School of Nursing, University of Pennsylvania.
J Nurs Regul. 2019 Jul;10(2):31-37. doi: 10.1016/s2155-8256(19)30113-9. Epub 2019 Jul 9.
The current shortage of physicians in the United States has potential to dramatically limit access to healthcare. Nurse practitioners (NPs) can provide a cost-effective solution to the shortage, yet few states allow NPs to practice independently.
The purpose of this study was to provide an up-to-date description of the NP workforce and to identify the professional and organizational factors associated with NP care quality.
Cross-sectional survey data from a sample of NPs actively employed in four states with reduced or restricted practice (California, Florida, New Jersey, and Pennsylvania) was used. NPs were categorized into acute and primary care. Regression models were fit to estimate the odds of three measures of care quality: overall quality of patient care, NP confidence that patients and their caregivers can manage their care at home, and whether NPs would recommend their practice facility to family and friends.
Receiving support from administrative staff and physicians was associated with an increase in the three measures of quality. The greatest effects were seen in primary care settings.
It is imperative that legislators and healthcare administrators implement policies that provide NPs with an environment that supports clinical practice and enhances care delivery.
美国目前的医生短缺有可能极大地限制医疗服务的可及性。执业护士（NP）可为这一短缺提供具有成本效益的解决方案，但很少有州允许执业护士独立执业。
本研究的目的是提供执业护士劳动力的最新情况描述，并确定与执业护士护理质量相关的专业和组织因素。
使用来自四个执业受限或受限制州（加利福尼亚州、佛罗里达州、新泽西州和宾夕法尼亚州）在职执业护士样本的横断面调查数据。执业护士分为急症护理和初级护理两类。采用回归模型来估计护理质量三项指标的几率：患者护理的总体质量、执业护士对患者及其护理人员能够在家中管理自身护理的信心，以及执业护士是否会向家人和朋友推荐其执业机构。
获得行政人员和医生的支持与质量的三项指标提高相关。在初级护理环境中效果最为显著。
立法者和医疗保健管理人员必须实施相关政策，为执业护士提供支持临床实践并改善护理服务的环境。
