Background: Policy makers and healthcare organizations are calling for expansion of the nurse practitioner (NP) workforce in primary care settings to assure timely access and high-quality care for the American public. However, many barriers, including those at the organizational level, exist that may undermine NP workforce expansion and their optimal utilization in primary care.
Objectives: This study developed a new NP-specific survey instrument, Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP-PCOCQ), to measure organizational climate in primary care settings and conducted its psychometric testing.
Methods: Using instrument development design, the organizational climate domain pertinent for primary care NPs was identified. Items were generated from the evidence and qualitative data. Face and content validity were established through two expert meetings. Content validity index was computed. The 86-item pool was reduced to 55 items, which was pilot tested with 81 NPs using mailed surveys and then field-tested with 278 NPs in New York State. SPSS 18 and Mplus software were used for item analysis, reliability testing, and maximum likelihood exploratory factor analysis.
Results: Nurse Practitioner Primary Care Organizational Climate Questionnaire had face and content validity. The content validity index was .90. Twenty-nine items loaded on four subscale factors: professional visibility, NP–administration relations, NP–physician relations, and independent practice and support. The subscales had high internal consistency reliability. Cronbach’s alphas ranged from.87 to .95.
Discussion: Having a strong instrument is important to promote future research. Also, administrators can use it to assess organizational climate in their clinics and propose interventions to improve it, thus promoting NP practice and the expansion of NP workforce.
Lusine Poghosyan, PhD, MPH, RN, is Assistant Professor, School of Nursing, Columbia University, New York.
Angela Nannini, PhD FNP-C, FAANP, is Associate Professor, Department of Nursing, University of Massachusetts Lowell.
Stacey R. Finkelstein, PhD, MBA, is Assistant Professor of Health Policy and Management, Mailman School of Public Health, Columbia University, New York.
Emanuel Mason, EdD, MEd, is Professor, Department of Counseling and Applied Educational Psychology, Northeastern University, Boston, Massachusetts.
Jonathan A. Shaffer, MS Biostats, PhD, is Assistant Professor of Clinical Medical Sciences, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York.
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Accepted for publication May 29, 2013.
We would like to thank the experts who participated in the panel discussions and the Nurse Practitioner Association New York State in assisting with the data collection.
The study is funded by the Center for Health Policy, School of Nursing, Columbia University. The qualitative data used in the study were part of a larger qualitative investigation funded by the American Nurses Foundation.
The authors have no conflicts of interest to disclose.
Corresponding author: Lusine Poghosyan, PhD, MPH, RN, School of Nursing, Columbia University, 617 W. 168th Street, GB 219 New York, NY 10032 (e-mail: firstname.lastname@example.org).