Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study
Open accessAbstract
Background Health care systems globally are facing challenges of meeting the growing demand for primary care services due to a shortage of primary care physicians. Policy makers and administrators are searching for solutions to increase the primary care capacity. The effective utilization of nurse practitioners (NPs) has been proposed as a solution. However, organizations utilize NPs in variable capacities. In some settings, NPs serve as primary care providers delivering ongoing continuous care to their patients, referred to as patient panels, whereas in other settings they deliver episodic care. Little is known about why organizations deploy NPs differently.Objectives Investigate the NP role in care delivery-primary care providers with the own patient panels or delivering episodic care-within their organizations and understand how work environments affect their role.Design A cross-sectional survey design was used to collect data from primary care NPs.Settings The study was conducted in one state in the United States (Massachusetts). Data from 163 primary care organizations was obtained, which employed between one to 12 NPs.Participants 807 NPs recruited from the Massachusetts Provider Database received mail surveys; 314 completed and returned the survey, yielding a response rate of 40%.Methods The survey contained measures of NP role in care delivery and work environment. NP role was measured by an item asking NPs to report if they deliver ongoing continuous care to their patient panel or if they do not have patient panel. The work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ). The multilevel Cox regression models investigated the influence of organization-level work environment on NP role in care delivery.Results About 45% of NPs served as primary care providers with their own patient panel. Organization-level Independent Practice and Support subscale, an NP-PCOCQ subscale, had a significant positive effect on NP role (risk ratio=2.33; 95% CI: 1.06-5.13); with a one unit increase on this subscale, the incidence of the NPs serving as primary care providers with their own patient panel doubled.Conclusions NPs can help meet the increasing demand for primary care by taking responsibilities as primary care providers, and organizations can assign NPs their own patient panels. Supporting NP independent practice within organizations promotes NP role as primary care providers. Policy and organizational change focused on promoting NP work environments so NPs can practice as primary care providers can be an effective strategy to increase the primary care capacity.
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Increased involvement of non-physicians such as Registered Nurses and Nurse Practitioners has long been recognized as an effective way to enhance access to primary care services.
“Increased involvement of non-physicians such as Registered Nurses (RNs) and Nurse Practitioners (NPs) has long been recognized as an effective way to enhance access to primary care services.6-12”
From Evaluating the cost of NP-led vs. GP-led primary care in British Columbia (2024) · cites this paper as [10]
The Introduction describes better use of nurse practitioners as a widely used strategy to increase primary-care capacity, and the Discussion says they can increase access to care. The cited paper does not establish the same point for registered nurses, whom the citing sentence also names. (LLM, conf=0.86)
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- Authors
- Poghosyan, L., Liu, J., & Norful, A. A.
- Affiliations
- Columbia University (US)
- Corresponding author
- Poghosyan, Lusine
- Venue
- International Journal of Nursing Studies
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 74
- Pages
- 1-7
- ISSN
- 0020-7489 (ISSN-L)
- PMC
- PMC6342506
- OpenAlex
- W2618995730
- Cited by
- 74
- References
- 62
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 14 · 2023: 11 · 2022: 11 · 2021: 9 · 2020: 11 · 2019: 5 · 2018: 5
- FWCI
- 9.27
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- International Journal of Nursing Studies (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Agency for Healthcare Research and Quality (R03HS020999)
- National Institute of Nursing Research (T32NR014205)
- Topics
- Health Sciences › Health Professions › General Health Professions › Nursing Roles and Practices
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Health Sciences › Health Professions › General Health Professions › Interprofessional Education and Collaboration
- Keywords
- nurse practitioners, primary care, patient panel, episodic care, work environment, organizational climate, independent practice, primary care capacity, primary care workforce shortage
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Humans, Male, Massachusetts, Middle Aged, Nurse Practitioners, Nurse-Patient Relations, Primary Health Care, United States, Nurse's Role
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