School of Nursing, Columbia University, New York, New York, USA.
School of Nursing, University of California, San Francisco, California, USA.
Res Nurs Health. 2022 Oct;45(5):516-524. doi: 10.1002/nur.22253. Epub 2022 Jul 19.
Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational-level work environment of NPs. Through a cross-sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018-2019. Arizona and Washington had full SOP-NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP-Administration Relations (NP-AR), NP-Physician Relations (NP-PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models assessed the relationship between state-level SOP and practice-level NP work environment. NP-AR scores were higher in full SOP states compared to reduced (β = 0.22, p < 0.01) and restricted (β = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (β = 0.16, p < 0.001) and restricted (β = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP-PR score. State-level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with administration and report more role visibility and support. Efforts should be made to remove unnecessary SOP restrictions.
执业护士（NP）的实践范围（SOP）政策在美国各地有所不同。对于这些政策对医疗保健组织中 NP 工作环境的影响知之甚少。我们调查了 SOP 政策与 NP 组织层面工作环境之间的关联。通过横断面调查设计，于 2018-2019 年在六个 SOP 法规不同的州（亚利桑那州、新泽西州、华盛顿州、宾夕法尼亚州、德克萨斯州和加利福尼亚州）收集了 1244 名 NP 的数据。亚利桑那州和华盛顿州的 SOP 为完全执业护士拥有全面提供护理的权力。新泽西州和宾夕法尼亚州的 SOP 有执业限制并要求与医生合作；加利福尼亚州和德克萨斯州的 SOP 有执业限制并要求在医生监督下进行。NP 完成了包含执业护士初级保健组织气候问卷的邮件或在线调查，该问卷包含以下子量表：执业护士-管理关系（NP-AR）、执业护士-医生关系（NP-PR）、独立实践和支持（IPS）和专业可见度（PV）。回归模型评估了州级 SOP 与实践层面 NP 工作环境之间的关系。与限制（β=0.15，p<0.01）和限制（β=0.15，p<0.01）SOP 州相比，完全 SOP 州的 NP-AR 评分更高。同样，完全 SOP 州的 IPS 评分也更高。与限制（β=0.12，p<0.05）SOP 州相比，完全 SOP 州的 PV 评分也更高。SOP 与 NP-PR 评分之间没有关系。州级政策会影响 NP 的工作环境。在政策更有利的州，NP 与管理部门的关系更好，报告更多的角色可见度和支持。应努力消除不必要的 SOP 限制。
