Identifying service quality gaps between patients and providers in a Native American outpatient clinic.

BACKGROUND: Native American communities in Montana reservations have reported low-level satisfaction in health services. This research explored if the services provided at a Blackfeet Indian Reservation outpatient clinic were designed to meet patient expectations. METHODS: Staff and patient interviews and surveys allowed service expectations to be assessed according to the clinic's ability to meet those expectations. A total of 48 patients and ten staff members (83% of the staff at this clinic) participated in the study voluntarily. RESULTS: We found a disconnect between what patients anticipate for care and what staff think they are anticipating. We also found a discontent between what staff believes patients need versus what the patients feel is needed. CONCLUSIONS: These gaps combine to increase the breach between patient expectations and perceptions of their healthcare services. With better insight that captures what patients are looking for from a service, the potential to meet those needs increases, and patients feel that their voice is respected and valued.

Understanding the Roles, Responsibilities, and Competencies of Advanced Practice Registered Nurses: Instrument Development and Psychometric Testing.

BACKGROUND AND PURPOSE: Demand for primary care providers increases value for advanced practice registered nurses (APRNs) to assume more independent roles. The purpose was to develop a reliable, valid instrument to measure roles, responsibilities, and competencies reflective of autonomous practice for APRNs. METHODS: Conceptual literature motivated development of a new instrument. Validity was initially evaluated through expert content review. Reliability of proposed scales was evaluated and possible underlying constructs were identified through factor analysis using data from a pilot study. RESULTS: Content validity for the instrument was high (content validity index [CVI] 88). The 16-item instrument is highly reliable (Cronbach's alpha of 0.81). Cronbach's alphas for subscales ranged from 0.60 to 0.75. Factor analysis identified four components. CONCLUSIONS: The Petersen Sieloff Assessment of Advanced Practice (PSAAP) demonstrated initial reliability. Additional examination is warranted to further improve the factor structure.

The role of physician oversight on advanced practice nurses' professional autonomy and empowerment.

BACKGROUND AND PURPOSE: Little is known about the effects of physician oversight on advanced practice registered nurses (APRNs). Examination of these relationships provides insight into the strength of independent practice. The purpose of this study was to examine whether APRNs' perceptions of autonomy and empowerment varied according to type of physician oversight, whether facilitative or restrictive. DATA SOURCES: A cross-sectional survey design was used to examine whether APRNs' perceptions of autonomy and empowerment varied according to physician oversight, geographical location, and practice setting. Five hundred questionnaires were mailed in March 2013 with 274 returned. Participants were asked about autonomy, empowerment, demographics, physician oversight, geographical location, and practice setting. CONCLUSIONS: Among surveyed respondents, physician oversight was related to increased empowerment, regardless of whether the oversight was defined in facilitative or restrictive terms; both had similar positive effects on empowerment. IMPLICATIONS FOR PRACTICE: If APRNs are to be part of the solution to the growing problem of healthcare access, it is important to study factors that contribute to their success. We speculate that increasing opportunities for collaboration and interaction with physicians, and possibly other healthcare professionals, could facilitate APRN empowerment, optimizing their contribution.

Autonomy and empowerment in advanced practice registered nurses: lessons from New Mexico.

PURPOSE: The purpose of this study was to determine the association between autonomy and empowerment of advanced practice registered nurses (APRNs) and predictor variables of physician oversight, geographical location, and practice setting. As the Patient Protection and Affordable Care Act (PPACA) is implemented, these characteristics are vital to understanding how APRNs practice and the relationship of APRNs to other healthcare team members, including physicians. DATA SOURCES: This was a descriptive, correlational survey of APRNs in New Mexico exploring autonomy and empowerment in relation to variables of physician oversight, geographical location, and practice setting. CONCLUSIONS: New Mexico's APRN Nurse Practice Act supports independent practice and prescriptive authority. Results indicated that APRNs are highly empowered and autonomous. However, nearly 40% of respondents identified practicing with physician oversight. Further investigation of subscales of empowerment also provided insight of relationships among healthcare team members, particularly physicians. IMPLICATIONS FOR PRACTICE: This research provides additional knowledge for policy changes that support APRNs assuming more responsibility for primary care. However, understanding the APRN role within the healthcare team is necessary for effective implementation of primary care in New Mexico.