A national survey of nurse practitioners' patient satisfaction outcomes.

BACKGROUND: The research findings about nurse practitioner (NP) patient experiences (satisfaction) are limited to small sample sizes from local community clinics. No national studies with large sample sizes were found. PURPOSE: To analyze responses from the Consumer Assessment of Healthcare Providers and Systems survey and compare the patient experiences from four different provider categories. METHODS: Secondary data analysis was completed on survey responses from 53,885 patients. FINDINGS: In the sample, medical doctor providers were disproportionately represented in greater number than NPs, doctor of osteopathy, or physician assistant. Further analysis comparing patient experiences between providers revealed NP to be rated significantly higher than their colleagues. DISCUSSION: Recognizing the factors associated with patient satisfaction with their providers can lead to improvements in patient-provider interactions that can result in increased quality of care. CONCLUSION: Policy makers should find opportunities to employ NP in primary care settings and achieve greater patient satisfaction that can influence outcomes associated with patient-centered care initiatives.

Nurse practitioners' time on nonbillable activities.

BACKGROUND AND PURPOSE: During the provision of patient care delivery, all providers, including nurse practitioners (NPs), spend some time in activities that are not reimbursable. Understanding these nonbillable activities is crucial to the economic viability and success of existing and projected practice models. This study explored and compared seven nonbillable activities occurring in the practices of NPs in various settings. METHODS: Using a nonexperimental, descriptive design, 509 NPs were surveyed about nonbillable activities encountered in daily practice. Binomial regression analyses and incidence rate ratios were used to interpret relationships between each variable and nonbillable time. CONCLUSIONS: Although not every variable had significance, there were significant differences found in the amount of time spent in certain nonbillable activities depending on workplace setting, number of support staff, and primary care provider role. IMPLICATIONS FOR PRACTICE: The uncertainty of health care reform, including reimbursement, provider shortage, and the expanding roles of NPs, requires a closer look at both billable and nonbillable care activities. Understanding how nonbillable time affects work efficiency, costs, and the value of NPs will allow NPs to influence future health care reimbursement policies and delivery care models.

The Southern states: NPs made an impact in rural and healthcare shortage areas.

PURPOSE: To investigate the distribution of nurse practitioners (NPs) in the U.S. Southern region with a focus on rural and underserved areas. Described in this study are the NP characteristics and their workforce distribution relative to rural and health professional shortage areas (HPSAs). METHOD: A questionnaire was administered to NPs in 12 Southern states. Other data sources included (a) the Health Resources and Services Administration, which identified HPSAs; and (b) data from the U.S. Census Bureau, to distinguish urban and rural areas. CONCLUSIONS: Approximately 72% of NPs worked in HPSAs and less than half of the NPs worked in the rural area. Family NPs were more likely to practice in rural and HPSAs. Employment in primary care was more likely to occur in rural and HPSAs. Racial diversity was almost nonexistent within the NP population. IMPLICATION FOR PRACTICE: This research does demonstrate that NPs are practicing in rural and underserved areas as conceived decades ago, but there is still a great demand and gap to fill. To optimize their effectiveness, NPs need to practice to the full extent of their education. Additionally, more research and strategies to help diversify the workforce is needed.

Minimal changes and missed opportunities: a decade look at nurse practitioners in the lower Mississippi River Delta states.

The U.S. southern region has one of most socioeconomically deprived and poorest health care outcomes in the county. The aims of this study were to determine changes of nurse practitioners (NPs) and their practice in lower Mississippi River Delta over the past decade and to examine differences of NPs' employment in health professional storage areas (HPSAs) and rural areas. A nonexperimental quantitative survey technique was used in the years 2000 and 2010. Other data sources included Health Resources and Services Administration that identified HPSA and the U.S. Census Bureau used to distinguish urban and rural areas. NPs are younger, and more are graduates of master's and doctorate degrees, but they are not reflective of the race they serve. Approximately, 25% of NPs worked in HPSA, and 50% worked in the rural area both in 2000 and in 2010. This proportion has remained blatantly steady during the past decade. Employment in rural health centers and family practice as a specialty declined; however, self-employment was on the rise. Nursing schools and health care institutions should be collaborating to develop plans and implementation strategies to recruit and retain NPs in the Mississippi River Delta rural and HPSAs.

Measured emotional intelligence ability and grade point average in nursing students.

BACKGROUND: For most schools of nursing, grade point average is the most important criteria for admission to nursing school and constitutes the main indicator of success throughout the nursing program. In the general research literature, the relationship between traditional measures of academic success, such as grade point average and postgraduation job performance is not well established. In both the general population and among practicing nurses, measured emotional intelligence ability correlates with both performance and other important professional indicators postgraduation. Little research exists comparing traditional measures of intelligence with measured emotional intelligence prior to graduation, and none in the student nurse population. OBJECTIVE: This exploratory, descriptive, quantitative study was undertaken to explore the relationship between measured emotional intelligence ability and grade point average of first year nursing students. DESIGN SETTING AND SAMPLE: The study took place at a school of nursing at a university in the south central region of the United States. Participants included 72 undergraduate student nurse volunteers. METHODS: Emotional intelligence was measured using the Mayer-Salovey-Caruso Emotional Intelligence Test, version 2, an instrument for quantifying emotional intelligence ability. Pre-admission grade point average was reported by the school records department. RESULTS: Total emotional intelligence (r=.24) scores and one subscore, experiential emotional intelligence(r=.25) correlated significantly (>.05) with grade point average. CONCLUSIONS: This exploratory, descriptive study provided evidence for some relationship between GPA and measured emotional intelligence ability, but also demonstrated lower than average range scores in several emotional intelligence scores. The relationship between pre-graduation measures of success and level of performance postgraduation deserves further exploration. The findings of this study suggest that research on the relationship between traditional and nontraditional measures of academic success, and emotional intelligence correlation with postgraduation performance, is warranted.

Gaps in the primary care of rural and underserved populations: the impact of nurse practitioners in four Mississippi Delta states.

PURPOSE: The shortage and distribution of primary care providers (PCPs) has left a gap in the health care of society, particularly those residents within the Lower Mississippi River Delta region, where pockets of rural and underserved populations reside. Described in this study are the workforce distribution, characteristics, and likelihood of advanced practice nurses (APNs) to practice in these communities. DATA SOURCES: Surveys were completed by 479 APNs in Arkansas, Louisiana, Mississippi, and Tennessee. Other sources included census data and the designation of Health Professional Shortage Areas as specified by Health Resources and Services Administration. CONCLUSIONS: Fifty-one percent of respondents indicated they practice in primary care; 24% practice in a designated Health Professional Shortage Areas; and 54% practice in a rural area. Family nurse practitioners (FNPs), in particular, were more likely to practice in rural and shortage areas. IMPLICATIONS: More APNs, especially nurse practitioners (NPs), are needed to address the PCP shortage. But more than just increased numbers of NPs is the need for redistribution of these providers. Efforts to expand the scope of practice and limit regulatory restrictions will enable NPs to practice more autonomously, which in turn will provide opportunities for better access and improved healthcare outcomes, especially in rural and underserved regions. Educational programs must include competencies and skill sets focused on meeting the needs of these populations.

Advanced Practice Nurses' Meaningful use of electronic health records.

AIM: The aim of this study was to better understand electronic health records (EHRs) use among advanced practice nurses (APNs). BACKGROUND: EHRs are becoming an integral part of the U.S. health care system. Federal law was enacted with provisions that offer incentive payments to eligible professionals and hospitals who use EHRs. Little is known about APNs' EHR use. METHODS: A quantitative, non-experimental research design was used. Descriptive and multiple logistic regression analyses were performed. RESULTS: Two thirds of the APNs were EHR-user. Statistically significant differences between EHR-users and non-users were found in age categories, practice setting, practice size, and in tasks related to imagery report review and care coordination. EHR use was associated with higher odds of practicing in hospital, and employment longevity, but with decreased odds in the number of patients seen per day. CONCLUSIONS: With one third of the APNs being EHR non-users, more efforts are needed to help guide the adoption and diffusion of EHRs in practice.

Teaching evidence-based practice: the Bachelor of Science in nursing essentials at work at the bedside.

Patient safety and quality outcomes are major issues in the health care industry. Many national organizations have pushed these issues to the forefront of health care, demanding that health care professionals, especially nurses, play a vital role and be vigilant in these endeavors. Nurse educators, using The Essentials of Baccalaureate Education for Professional Nursing Practice, are in a unique position to impact health care systems and patient care by educating and training nursing students in the skills necessary to promote safety and quality outcomes. This article describes a creative, authentic learning experience that is currently being used in a Bachelor of Science in Nursing (BSN) program. The learning experience is a shared partnership between the clinical agency, the faculty, and the health science librarian to assist senior nursing students in the last semester of their baccalaureate degree program to synthesize and use the knowledge, skills, and attitudes that promote patient safety and optimal outcomes. It is a teaching strategy that incorporates many of the outcomes from the BSN Essentials and aids students to actively seek and deliver care using evidence-based practice.

Teaching quality improvement to the next generation of nurses: what nurse managers can do to help.

Engaging staff in performance improvement and patient safety initiatives is no easy task. It is not just time that is involved but there is also a definite repertoire of knowledge, skills, and attitudes required. This article describes a win-win venture that assists healthcare agencies in improving current quality improvement activities while actively teaching and vetting students in the process. Nursing students enter the workforce with an appreciation and working knowledge of quality improvement, and agencies gain assistance with their programs and outcomes.