Examining variable nurse practitioner independence across jurisdictions: A case study of the United States

Feyereisen, Scott; Goodrick, Elizabeth

doi:10.1016/j.ijnurstu.2020.103633

Cited by 7 publications

(11 citation statements)

References 36 publications

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“…Once we coded both of these variables for each year in the observation period, we added them together to obtain a comprehensive autonomy level measure. States with a combined score of 2 we categorized as independent states (Category 1), scores of 3-4 we categorized as collaborative states (Category 2), and scores of 5-6 we categorized as supervision states (Category 3) (Feyereisen and Goodrick, 2020). Other state-level factors include physicians per 10,000 people and Advanced Practice Nurses per 10,000 people.…”

Section: Independent Variablesmentioning

confidence: 99%

A new kind of gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US hospitals

Feyereisen¹,

Puro

Thomas

et al. 2020

Health (London)

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Case management is a representation of managed care, cost-containment organizational practices in healthcare, where managed care and its constitutive parts are situated against physician autonomy and decision-making. As a professional field, case management has evolved considerably, with the role recently taken up increasingly by Advanced Practice Nurses in various health care settings. We look at this evolution of a relatively new work task for Advanced Practice Nurses using a countervailing powers perspective, which allows us to move beyond discussions of case management effectiveness and best practices, and draw connections to trends in the social organization of healthcare, especially hospitals. We evaluated organizational (hospital-level) and environmental (county and state-level) characteristics associated with hospitals’ use of Advanced Practice Nurses as case managers, using data from U.S. community acute care hospitals for 2016–2018, collected from three data sources: American Hospital Association annual survey (AHA), Centers for Medicare and Medicaid Services (CMS), and Area Resource File. Among organizational characteristics, we found that hospitals that are a part of established Accountable Care Organizations (OR = 2.55, p = 0.009; 95% CI = 1.26–5.14) and those that serve higher acuity patients, as indicated by possessing a higher Case Mix Index (OR = 1.32, p = 0.001; 95% CI = 1.13–1.55), were more likely to use Advanced Practice Nurses as case managers. Among environmental characteristics, having higher local Advanced Practice Nurses concentrations (OR = 1.24, p < 0.001; 95% CI = 1.11–1.39) was associated with hospital Advanced Practice Nurses case management service provision. Beyond the health impacts of Covid-19, its associated recession is placing families, governments and insurers under unprecedented financial stress. Governments and insurers alike are looking to reduce costs anywhere possible. This will inevitably result in increasing amounts of managed care, and decreasing reimbursements to hospitals, likely resulting in higher demand for APRN patient navigators.

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Section: Independent Variablesmentioning

confidence: 99%

A new kind of gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US hospitals

Feyereisen¹,

Puro

Thomas

et al. 2020

Health (London)

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“…This need may be high as past work found that NPs and PAs were not more likely to be located in areas with the greatest primary care need. 30,31 Another interesting result from the regression analysis was that increased numbers of health care professionals in a county is generally associated with an increase in FP scope score. One hypothesis is that increased numbers of physicians, particularly specialists, creates a substitution effect that would drive down scope of practice in FPs.…”

Section: Discussionmentioning

confidence: 96%

The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas

Nasim

Morgan²,

Peterson

2020

The Journal of Rural Health

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Purpose: Scope of practice of family physicians (FPs) has been decreasing overall. Our objective was to determine if the distribution of declining scope occurs across urban and rural settings. Methods:We used secondary data from practicing FPs collected on the American Board of Family Medicine examination registration demographic questionnaire from 2014 to 2016 on scope of practice merged with county-level data from the Area Health Resources File. Rurality was assigned using 4 populationbased groupings from the Rural Urban Continuum Codes. Outcome measures were scope of practice score (0-30, higher score reflecting broader scope) and provision of specific types of care/procedures. Bivariate statistics assessed changes in scope of practice over time. Adjusted regression models tested associations between time, physician, practice, and county characteristics with scope of practice score. Findings:Our sample was 27,343 practicing FPs. Overall, the scope score decreased from 15.5 to 15.0 (P value < .05) but was significant only for urban settings. Regression analysis found that scope decreased each year (β = -0.15), broader scope for rural FPs, and no interaction between year and rural. Conclusions:The decrease in FP scope of practice is largely an urban phenomenon. FPs in rural areas have a broad scope of practice, which may ensure access to care in rural areas that rely on FPs to provide a large portion of health care services. However, county characteristics like persistent poverty and the presence of nurse practitioners, physician assistants, and other physicians were associated with changes in scope that may modify the gains associated with rurality.

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“…In the United States, there has been a movement toward increasing supply, utilization and autonomy of advanced practice nurses (APNs) since the early 2000's (Feyereisen et al, 2018; Feyereisen & Goodrick, 2020; Feyereisen & Puro, 2020; Gadbois et al, 2015). APNs have more education and are often more specialized than Registered Nurses.…”

Section: Background and Theorymentioning

confidence: 99%

“…Regulations at the state level govern the ability of APNs to perform diagnosis and treatment, to prescribe medication, to bill insurance and receive reimbursement from federal programmes, to administer anaesthesia, and more. Although the legal responsibility to establish overall boundaries lies generally with state policymakers, these polices are constructed through a variety of social, political and economic influences, largely emanating from powerful professional associations (Feyereisen et al, 2018; Feyereisen & Goodrick, 2020; Zhou, 1993).…”

Section: Background and Theorymentioning

confidence: 99%

“…Nursing illustrates this trend. Increasing numbers of Advanced Practice Nurses (APNs), such as nurse practitioners (NPs), nurse anaesthetists (CRNAs), nurse midwives (NMWs) and clinical nurse specialists (CNSs), have in many cases taken on roles traditionally filled by physicians (Feyereisen & Goodrick, 2020; Feyereisen et al, 2021; Needleman & Minnick, 2009; Spetz et al, 2017). In the United States, APN autonomy varies based on state‐level laws.…”

Section: Introductionmentioning

confidence: 99%

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Physician dominance in the 21st century: Examining the rise of non‐physician autonomy through prevailing theoretical lenses

Feyereisen

McConnell

Thomas

et al. 2021

Sociology Health & Illness

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Theories of physician dominance are a foundational contribution of medical sociology to the study of health care, but must be revisited in the light of ongoing changes in medicine. As non‐physician specialists like nurse practitioners grow in number and acquire more autonomy, increasing medical profession differentiation presents a challenge for traditional physician dominance theories. After evaluating potential theoretical explanations for subordinate occupations' autonomy gains, we conduct a state‐level quantitative analysis of variation in nursing policies across U.S. states. We construct our dependent variable, nursing autonomy, using seven state‐level advanced practice nursing policies adopted from 2001–2017. Using an ordered scale, we code nurse practitioner, nurse anaesthetist, nurse midwife and clinical‐nurse‐specialist practice and prescription polices according to each policy's autonomy level. We then use time‐series regression to examine theory‐driven propositions regarding nursing autonomy change. Nursing autonomy has increased over time, signalling a general erosion of physician dominance. However, we find differential patterns of policy adoption, indicating that erosion is not uniform. Physicians have maintained dominance in relatively prestigious specialties (e.g. anaesthesiology) while dominance declined in others (e.g. obstetrician). Factors external to the profession, such as consumer power, continue to influence within‐profession dynamics. Examining ongoing professional differentiation in medicine illustrates how physician dominance depends on shifting social and professional contexts.

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Examining variable nurse practitioner independence across jurisdictions: A case study of the United States

Cited by 7 publications

References 36 publications

A new kind of gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US hospitals

A new kind of gatekeeper: The increasing prevalence of Advanced Practice Nurses as case managers in US hospitals

The Declining Scope of Practice of Family Physicians Is Limited to Urban Areas

Physician dominance in the 21st century: Examining the rise of non‐physician autonomy through prevailing theoretical lenses

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