Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas

Carthon, Margo Brooks; Brom, Heather; Nikpour, Jacqueline; Todd, Barbara; Aiken, Linda H.; Poghosyan, Lusine

doi:10.1016/s2155-8256(22)00028-x

Cited by 13 publications

(23 citation statements)

References 36 publications

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“…Several factors may help explain why states with restricted scope‐of‐practice regulations were more likely to have greater uptake of NP‐HBPC compared to full‐practice states. One potential factor is that in addition to scope‐of‐practice regulations, organizational characteristics of health systems employing NPs influence or create favorable practice environments for NPs 33 . Previous research has shown that practice settings that promote NP‐role visibility, autonomy, and professional collaboration between NPs and physicians and/or administrators favor NPs, and are associated with greater retention of NPs 34,35 .…”

Section: Discussionmentioning

confidence: 99%

“…One potential factor is that in addition to scope-ofpractice regulations, organizational characteristics of health systems employing NPs influence or create favorable practice environments for NPs. 33 Previous research has shown that practice settings that promote NP-role visibility, autonomy, and professional collaboration between NPs and physicians and/or administrators favor NPs, and are associated with greater retention of NPs. 34,35 Large HBPC healthcare delivery organizations in the private sector that play a dominant role in the delivery of HBPC may use a collaborative practice model between physicians and NPs, that while constraining some NP autonomy, may offer a rich interdisciplinary community and a culture of mutual respect that is appealing to some NPs.…”

Section: Allmentioning

confidence: 99%

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The role of restrictive scope‐of‐practice regulations on the delivery of nurse practitioner‐delivered home‐based primary care

Osakwe

Liu

Ankuda

et al. 2023

J American Geriatrics Society

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Background Nurse practitioners (NPs) are the largest group of providers delivering home‐based primary care (HBPC) in the U.S. We examined the association of scope‐of‐practice regulations and NP‐HBPC rates. Methods Using the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data Public Use File for 2019, we conducted a state‐level analysis to examine the impact of scope‐of‐practice regulations on the utilization of NP‐HBPC. Healthcare Common Procedure Coding System codes were used to identify the HBPC visits in private residences (99341–99,345, 99,347–99,350) and domiciliary settings (99324–99,328, 99,334–99,337). We used linear regression to compare NP‐HBPC utilization rates between states of either restricted or reduced scope‐of‐practice laws to states with full scope‐of‐practice, adjusting for a number of NP‐HBPC providers, state ranking of total assisted living, the proportion of fee‐for‐service (FFS) Medicare beneficiaries and neighborhood‐level socio‐economic status and race and ethnicity. Results Nearly half of NPs providing HBPC (46%; n = 7151) were in states with a restricted scope of practice regulations. Compared to states with full scope‐of‐practice, states with restricted or reduced scope‐of‐practice had higher adjusted rates of NP‐HBPC per 1000 FFS Medicare beneficiaries. The average level of the utilization rate of NP‐HBPC was 89.9, 63, and 49.1 visits, per 1000 FFS Medicare beneficiaries in states with restricted, reduced, and full‐ scope‐of‐practice laws, respectively. The rate of NP‐HBPC visits was higher in states with restricted (Beta coefficient = 0.92; 95%CI 0.13–1.72; p = 0.023) and reduced scope‐of‐practice laws (Beta coefficient = 0.91; 95%CI 0.03–1.79; p = 0.043) compared to states with full scope‐of‐practice laws. Conclusion Restricted state NP scope‐of‐practice regulations were associated with higher rates of FFS Medicare NP‐HBPC care delivery compared with full or reduced scope‐of‐practice. Understanding underlying mechanisms of how scope‐of‐practice affects NP‐HBPC delivery could help to develop scope‐of‐practice regulations that improve access to HBPC for the underserved homebound population.

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Section: Discussionmentioning

confidence: 99%

Section: Allmentioning

confidence: 99%

The role of restrictive scope‐of‐practice regulations on the delivery of nurse practitioner‐delivered home‐based primary care

Osakwe

Liu

Ankuda

et al. 2023

J American Geriatrics Society

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“…Restrictive scope of practice imposed by regulatory and other barriers further constrain the ability of APRNs to practice commensurate with their level of education and experiences ( Kleinpell et al, 2022 ). A recent study assessing the association between state scope-of-practice regulations, unsupportive practice environments, and self-reported ratings of quality of care in primary care practices located in healthcare professional shortage areas found that these items were associated with ratings of quality of care, with unsupportive environments having lower ratings of quality of care ( Carthon et al, 2020 ). Another study assessing state limitations on APRN scope of practice in five states identified that scope-of-practice regulations adversely affected practice settings.…”

Section: Aprn Practice Barriersmentioning

confidence: 99%

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19

Kleinpell

Myers

Schorn

2023

Journal of Nursing Regulation

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“…Because health care organizations produce the environment within which clinicians (and patients) are embedded, organizations have the power to perpetuate health inequities via unequal investments and distribution of resources (Hallett & Ventresca, 2006; Ray, 2019). Because studies have demonstrated the impact of organizational climates on NPs' care delivery and patient outcomes, we explored how the context of Black NPs' organizations influenced their ability to address inequities (Brooks Carthon et al, 2020, 2022; Poghosyan et al, 2018, 2022).…”

Section: Introductionmentioning

confidence: 99%

“I had become fed up”: A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout

Brooks Carthon,

Aponte,

Mason

et al. 2023

J Am Assoc Nurse Pract

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Background: Increasing diversity in the nurse practitioner (NP) workforce is key to improving outcomes among patients who experience health inequities. However, few studies to date have examined the specific mechanisms by which NPs from diverse backgrounds address inequities in care delivery. Purpose: To explore Black NPs' efforts in addressing inequities, and the facilitators and barriers they face in doing so. Methodology: We conducted focus groups and interviews of Black NPs (N = 16) in the greater Philadelphia area in early 2022, just following the height of the COVID-19 pandemic and the social unrest of the early 2020s. Data were analyzed using thematic analysis. Results: Emergent themes included: Strategies Utilized to Address Health Inequities; Burnout & the Minority Tax; Risks & Rewards of Taking a Stance; and Uneven Promises of Organizational Engagement. Nurse practitioners prioritized patient-centered, culturally congruent care, taking additional time to explore community resources and learn about patients' lives to facilitate care planning. Participants advocated to administrators for resources to address inequities while simultaneously navigating organizational dynamics, microaggressions, and racism. Finally, NPs identified organizational-level barriers, leading to emotional exhaustion and several participants' intent to leave their roles. Conclusions: Black NPs use a myriad of strategies to improve equity, yet frequently face substantial barriers and emotional exhaustion in doing so with little change to the inequities in care. Implications: The NP workforce has a critical role to play in reducing health inequities. The strategies outlined by Black NPs in this study offer a roadmap for all clinicians and health care organizations to prioritize equity in care delivery.

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Supportive Practice Environments Are Associated With Higher Quality Ratings Among Nurse Practitioners Working in Underserved Areas

Cited by 13 publications

References 36 publications

The role of restrictive scope‐of‐practice regulations on the delivery of nurse practitioner‐delivered home‐based primary care

The role of restrictive scope‐of‐practice regulations on the delivery of nurse practitioner‐delivered home‐based primary care

Addressing Barriers to APRN Practice: Policy and Regulatory Implications During COVID-19

“I had become fed up”: A qualitative study of Black nurse practitioners' experiences fighting against health inequity, racism, and burnout

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