Gender differences in nurse practitioners: job satisfaction and patterns of care.

BACKGROUND: Although workforce diversity has been cited as an important workforce issue, the contemporary U.S. nurse practitioner (NP) workforce is dominated by females. Provider diversity, specifically gender, has been found to directly influence patient preference. However, lack of gender diversity in the NP workforce has never been specifically evaluated in terms of job satisfaction and patterns of care. PURPOSE: The purpose of this study was to assess and evaluate NP gender, job satisfaction and practice patterns of care for U.S. clinical NPs. METHODS: This study used the 2012 National Sample Survey of Nurse Practitioners (NSSNP). Participants meeting inclusion criteria totaled 8,978 NPs, of which 92.8% were female. RESULTS: Although overall job satisfaction was not shown to be significantly different between genders, several patterns of care were found to be significant. Of the 11 measured patterns of care in the NSSNP, six were significantly different between genders, with a female majority indicating that they performed these services most often. In only one rendered service, performed medical procedures, did male NPs indicate that they did more than females. IMPLICATIONS FOR PRACTICE: This study suggests the importance of a gender-diversified U.S. nurse practitioner workforce. This is indicated by differences highlighted in patterns of care by NP gender, which has been postulated to influence patient outcomes, including perceived quality of care and engagement in the health care process. Patient preferences for same-gender NPs, particularly patients with privacy issues, warrant further exploration.

Examining the diverse perspectives of nurse practitioners regarding obstacles to diaphragm prescription: a latent class analysis.

BACKGROUND: The diaphragm is receiving renewed attention not only for its dual method potential but also because of improved design. To facilitate method re-introduction, we examined what providers think about this female-controlled barrier contraceptive. METHODS: A questionnaire administered to 450 women's health nurse practitioners (NPs) asked about their practice experience and issues concerning diaphragm use. Latent class analysis (LCA) was used to identify different groups of providers, based on patterns of perceptions regarding various potential obstacles to diaphragm use. Provider profiles were further described in terms of individual and practice characteristics. RESULTS: The survey achieved a 47% response rate (n = 214). Respondents saw, on average, 31 family planning patients/week; 87% had fitted a diaphragm, although only 40% had done so in the previous year. Three groups holding significantly different perceptions of obstacles to diaphragm prescription were identified. Group 1 (13% of respondents), with more practice experience in delivering women's healthcare and fitting diaphragms, considered all obstacles relatively inconsequential. Group 2 (40%) had comparatively minor concerns, whereas Group 3 (47%) perceived all issues as major obstacles. All groups stressed the diaphragm's limited promotion, and for 87% of the respondents, concerns about effectiveness and nonfamiliarity with the method also assumed more salience. CONCLUSIONS: Emerging statistical modeling approaches that go beyond standard aggregate analyses helped identify three groups of women's health nurse practitioners. By considering their diverse perceptions of potential obstacles to diaphragm use, strategies aimed at changing provider behaviors may be developed to reverse declining prescribing rates and retain the diaphragm as a viable reproductive healthcare option for women.

Advanced practice nursing in Canada: overview of a decision support synthesis.

The objective of this decision support synthesis was to identify and review published and grey literature and to conduct stakeholder interviews to (1) describe the distinguishing characteristics of clinical nurse specialist (CNS) and nurse practitioner (NP) role definitions and competencies relevant to Canadian contexts, (2) identify the key barriers and facilitators for the effective development and utilization of CNS and NP roles and (3) inform the development of evidence-based recommendations for the individual, organizational and system supports required to better integrate CNS and NP roles into the Canadian healthcare system and advance the delivery of nursing and patient care services in Canada. Four types of advanced practice nurses (APNs) were the focus: CNSs, primary healthcare nurse practitioners (PHCNPs), acute care nurse practitioners (ACNPs) and a blended CNS/NP role. We worked with a multidisciplinary, multijurisdictional advisory board that helped identify documents and key informant interviewees, develop interview questions and formulate implications from our findings. We included 468 published and unpublished English- and French-language papers in a scoping review of the literature. We conducted interviews in English and French with 62 Canadian and international key informants (APNs, healthcare administrators, policy makers, nursing regulators, educators, physicians and other team members). We conducted four focus groups with a total of 19 APNs, educators, administrators and policy makers. A multidisciplinary roundtable convened by the Canadian Health Services Research Foundation formulated evidence-informed policy and practice recommendations based on the synthesis findings. This paper forms the foundation for this special issue, which contains 10 papers summarizing different dimensions of our synthesis. Here, we summarize the synthesis methods and the recommendations formulated at the roundtable.

Using the nursing interventions classification to describe the work of the nurse practitioner.

PURPOSE: To extend the specialty use research based on the Iowa Intervention Project using the Nursing Interventions Classification (NIC) and identify and the 20 most prevalent interventions described by practicing nurse practitioners (NPs). DATA SOURCES: A descriptive survey using a mailed questionnaire was sent to 1,190 NPs with prescriptive authority in Minnesota. Results are based on 414 (37%) useable responses. CONCLUSIONS: Of the 486 NIC interventions on the questionnaire, NPs reported using an average of 120 at least once per month. The 20 most frequently selected were reported by 71%-90% of respondents as being used at least once per month. Four core interventions (documentation, telephone consultation, teaching: prescribed medication, and emotional support) were common to NPs in all specialties. IMPLICATIONS FOR PRACTICE: Common medical coding does not reflect the nursing aspects of NP practice. As NPs attempt to define what is different about NP practice, the use of a standardized nursing language such as the NIC may facilitate this process. One clarification that needs to be made with regard to the NIC in future research with NPs is the distinction between prescribing and performing the interventions.

Measuring practice patterns among acute care nurse practitioners.

OBJECTIVE: This initiative was designed to develop a reliable instrument to measure the activities of acute care nurse practitioners (ACNPs). A sound, standardized method for measuring ACNP productivity will assist nursing leaders and administrators to demonstrate the effectiveness and productivity of ACNPs in and across institutions and systems. BACKGROUND DATA: Current research on ACNPs uses many different methodologies and research designs, and fails to provide standard definitions to measure practice patterns, making it difficult to generalize across settings. METHODS: Advisory groups from 2 New York academic health science centers developed a survey that covered the demographic, educational, and employment characteristics of ACNPs, and a 20-item classification of advanced practice nursing activities. Sixty-one ACNPs completed surveys, a 58% response rate. RESULTS: The survey found strong similarities at both institutions. ACNPs spend most of their time in 5 activities involving direct care and 4 activities within indirect care. Strong Cronbach alphas confirmed that the instrument was reliable. CONCLUSIONS/IMPLICATIONS: The availability of a reliable instrument for measuring ACNP practice patterns provides administrators with a powerful tool to demonstrate the contributions of their ACNPs. In addition, a standardized method for data collection can contribute to healthcare workforce policy discussions.

Classifying specialist student practice: debates and dilemmas.

At present, the practice elements of the Specialist Community Practitioner Awards within the BSc (Hons) in the Community Health degree course at Manchester Metropolitan University do not directly contribute to degree classification. Student evaluation and external examiner concerns about the heavy assessment load motivated the course team to consider classifying practice at 20 Level III credits which would replace 20 theory credits. The process of developing a credible assessment tool for specialist practice was long and hard but the course team is now in a position to undertake an exploratory study of the assessment and classification of practice. This paper provides an overview of the discussion and debates that took place in the years before the study began. A future paper will provide detail of the study and will include practice educators, students and managers views on the structure, process and outcomes of marking specialist student practice in community settings.

Correlates of nurse practitioners' diagnostic and intervention performance for domestic violence.

The purposes of this research were to identify diagnosis and intervention performance accuracy, variables that influence this performance accuracy, and barriers that impede performance accuracy of adult nurse practitioners (ANP) and family nurse practitioners (FNP) for domestic violence. Two measures were developed: the Nurse Practitioner Survey (NPS) and the Nurse Practitioner Performance Tool. A total of 118 ANPs and FNPs completed and returned mailed surveys. Of these, 22 individuals were interviewed by telephone regarding personal and professional experience with domestic violence and barriers in their clinical settings to addressing domestic violence.

A unique perspective on advanced practice nursing.

This article presents a working definition of the advanced practice registered nurse (APRN). The types of nurses that could be included in this definition and the benefits of broadening the category are discussed, as well as possible reasons for the less inclusive, previous definition of this category. Strategies are proposed for resolving concerns about broadening the category.