基层医疗执业护士的全面执业权限与职业倦怠
Full practice authority and burnout among primary care nurse practitioners.
作者信息
O'Connor Allyson W, Helfrich Christian D, Nelson Karin M, Sears Jeanne M, Jensen Penny Kaye, Engstrom Christine, Wong Edwin S
机构信息
Department of Health Systems and Population Health, University of Washington, Seattle, WA.
Department of Health Systems and Population Health, University of Washington, Seattle, WA; Center for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA.
出版信息
Nurs Outlook. 2023 Nov-Dec;71(6):102056. doi: 10.1016/j.outlook.2023.102056. Epub 2023 Oct 17.
BACKGROUND
Full practice authority (FPA) improves clinical autonomy for nurse practitioners (NPs). Autonomy may reduce burnout.
PURPOSE
Estimate the effect of changing from reduced or restricted practice authority to FPA on NP burnout.
METHODS
In this quasi-experimental study, we compared NP burnout before (2016) and after (2018) a Veterans Health Administration (VHA) regulation authorized NP FPA. Burnout proportions were estimated for VHA facilities by aggregating responses to the VHA's All Employee Survey from 1,352 primary care NPs.
DISCUSSION
Seventy-seven percent of facilities changed to FPA postregulation. Burnout was six points lower among NPs in facilities that changed to FPA compared to facilities that had FPA prior to the regulation; however, this association was not statistically significant.
CONCLUSION
NPs are increasingly working under independent practice. While changing to FPA did not reduce NP burnout, this association may vary by health care setting or when burnout is measured for individuals or teams.
背景
全面执业权（FPA）提高了执业护士（NP）的临床自主性。自主性可能会减少职业倦怠。
目的
评估从有限或受限执业权转变为全面执业权对执业护士职业倦怠的影响。
方法
在这项准实验研究中，我们比较了退伍军人健康管理局（VHA）一项授权执业护士全面执业权的规定实施之前（2016年）和之后（2018年）执业护士的职业倦怠情况。通过汇总1352名基层医疗执业护士对VHA全员工调查的回复，估算了VHA各机构的职业倦怠比例。
讨论
77%的机构在规定实施后转变为全面执业权。转变为全面执业权的机构中的执业护士的职业倦怠程度比规定实施前就拥有全面执业权的机构中的执业护士低6个百分点；然而，这种关联在统计学上并不显著。
结论
执业护士越来越多地在独立执业环境下工作。虽然转变为全面执业权并没有降低执业护士的职业倦怠，但这种关联可能因医疗环境不同，或者在对个人或团队进行职业倦怠评估时有所不同。
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