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Nurse practitioners as primary care providers: Creating favorable practice environments in New York State and Massachusetts

Poghosyan, Lusine; Shang, Jingjing; Liu, Jianfang; Poghosyan, Hermine; Liu, Nan; Berkowitz, Bobbie

doi: 10.1097/HMR.0000000000000010

Background: Policy makers, health care organizations, and health professionals are calling for the expansion of the nurse practitioner (NP) workforce in primary care to ensure access to high-quality, cost-effective care. However, to date, little is known about NP practice environments in primary care settings and how they may affect the expansion of this workforce and their practice.

Purposes: The aims of this study were to investigate NP practice environments in two states, Massachusetts (MA) and New York State (NY), and determine the impact of state and organization on NP practice environment.

Methodology: A cross-sectional survey design was used. Practice environments were measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire in terms of NP–physician relations, NP–administration relations, support, NP role comprehension, and NP independent practice. In MA, 291 NPs were recruited from the Massachusetts Provider Database through mail surveys. In NY, 278 NPs were recruited from the NY Nurse Practitioner Association membership list through online surveys. Data were collected from May through September 2012. Descriptive statistics were computed. Multivariate analysis of variance was conducted to investigate the effect of state and organization type on NP practice environments.

Findings: Nurse practitioners reported favorable relationships with physicians, deficiencies in their relationships with administrators, and lack of support. Nurse practitioners from MA reported better practice environments. Nurse practitioners from hospital-affiliated practices perceived poorer practice environments than did NPs practicing in physician offices and community health centers.

Practice Implications: Optimal working relations with physicians and administration, access to resources, and clarity in NP role are necessary to create practice environments where NPs can function effectively as primary care providers.

Lusine Poghosyan, PhD, MPH, RN, is Assistant Professor, Columbia University School of Nursing, New York. E-mail:

Jingjing Shang, PhD, RN, OCN, is Assistant Professor, Columbia University School of Nursing, New York.

Jianfang Liu, PhD, MAS, is Data Analyst, Columbia University School of Nursing, New York.

Hermine Poghosyan, PhD, MPH, is Assistant Professor, College of Nursing and Health Sciences, University of Massachusetts Boston.

Nan Liu, PhD, is Assistant Professor, Department of Health Policy and Management Mailman School of Public Health, Columbia University, New York.

Bobbie Berkowitz, PhD, RN, CNAA, FAAN, is Dean and Mary O’Neil Mundinger Professor, Columbia University School of Nursing, New York.

This study was funded by the Agency for Healthcare Research and Quality, and internal funding was received from the Columbia University School of Nursing. This article was presented and supported in part by the 2012 Michigan Symposium on Effectiveness and Implementation Science, sponsored by the University of Michigan School of Nursing, on September 26, 2012. The study was approved by the Institutional Review Board of Columbia University Medical Center.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

© 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins