Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts.
College of Nursing and Professional Disciplines, University of North Dakota, Grand Forks, North Dakota.
J Am Assoc Nurse Pract. 2023 Apr 1;35(4):235-241. doi: 10.1097/JXX.0000000000000853.
In January 2021, Massachusetts granted nurse practitioners (NPs) full-practice authority (FPA). Little is known about how FPA changes the day-to-day work of NPs.
To examine changes in practice barriers and care delivery in the early stages of FPA.
Descriptive analysis of a web-based survey of clinically active NPs in Massachusetts from October to December 2021, using Fisher exact tests to examine the associations between the perception that FPA improved work and other variables.
Survey response rate was 50.3% ( N = 147). Overall, 79% of NPs believe that clinical work is unchanged by FPA. Practicing outside institutions is a significant predictor of FPA improving work ( p < .05). Larger proportions of respondents feel that efficiency (22%), patient centeredness (20%), and timeliness (20%) are improved by FPA compared with effectiveness (16%), equity (14%), and safety (10%). Almost half of those reporting that FPA improves overall care also report improved efficiency (50%, p < .0001), but only 22% report improved safety ( p < .05). Of those believing that FPA improved work, a minority no longer need physician review of new controlled substance prescriptions (29%, p < .01), a practice agreement (32%, p < .05), or physician signature on clinical documentation (22%, p < .05).
Almost 1 year after FPA was passed in Massachusetts, the large majority of NPs report no changes in their day-to-day work, suggesting that FPA implementation is slow.
Concerted efforts by regulators, employers, and individual NPs are needed to ensure that legislated FPA is effectively implemented inside organizations and among payers.
2021 年 1 月，马萨诸塞州赋予了执业护士（NP）完全执业权限（FPA）。目前，对于 FPA 如何改变 NP 的日常工作，人们知之甚少。
在 FPA 的早期阶段，研究实践障碍和护理服务提供方面的变化。
对 2021 年 10 月至 12 月期间，马萨诸塞州临床活跃的 NP 进行的一项基于网络的调查进行描述性分析，使用 Fisher 精确检验来检验对 FPA 改善工作的看法与其他变量之间的关联。
调查的回复率为 50.3%（N=147）。总体而言，79%的 NP 认为 FPA 对临床工作没有影响。在机构外执业是 FPA 改善工作的一个显著预测因素（p<0.05）。与有效性（16%）、公平性（14%）和安全性（10%）相比，更大比例的受访者认为 FPA 提高了效率（22%）、以患者为中心（20%）和及时性（20%）。报告 FPA 整体改善护理的受访者中，近一半（50%，p<0.0001）报告提高了效率，但只有 22%（p<0.05）报告提高了安全性。在认为 FPA 改善工作的人群中，少数人不再需要医生审查新的受控物质处方（29%，p<0.01）、实践协议（32%，p<0.05）或医生在临床文件上的签名（22%，p<0.05）。
在马萨诸塞州通过 FPA 近 1 年后，绝大多数 NP 报告他们的日常工作没有变化，这表明 FPA 的实施进展缓慢。
监管机构、雇主和个体 NP 需要共同努力，以确保在组织内和支付方中有效实施立法规定的 FPA。
