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Job satisfaction and empowerment of self-employed nurse practitioners

A mixed methods study

Lyden, Catherine PhD, RN, FNP-C, CCRN (Assistant Professor)1; Sekula, L. Kathleen PhD, PMHCNS, FAAN (Professor)2; Higgins, Barbara PhD, APRN-BC, FAANP (Women's Health Clinical Mentor)3; Zoucha, Rick PhD, APRN-BC, CTN-A (Professor)2

Journal of the American Association of Nurse Practitioners: February 2018 - Volume 30 - Issue 2 - p 78–91
doi: 10.1097/JXX.0000000000000007
Research - Mixed Methods

Background and Purpose: Self-employed nurse practitioners (NPs) have been part of the American health care landscape since the 1970s, owning practices throughout the United States. The purpose of this study was to explore and measure the 2 characteristics of job satisfaction and empowerment in self-employed NPs practicing within the 50 states and District of Columbia and to explore factors that influence these characteristics.

Methods: A convergent parallel design, mixed methods study, using a survey and semistructured interviews, was completed. The survey included the Misener Job Satisfaction Survey and Conditions of Work Effectiveness Questionnaire II.

Conclusions: Self-employed NPs are satisfied and empowered. The more empowered, the higher their level of job satisfaction. Over 40% practiced with full practice authority in a rural location, and 50% had over 10 years of experience as both an RN and NP. Their experience in private practice was explored further in the interviews.

Implications for practice: This study identifies barriers to job satisfaction and empowerment in self-employed NPs, including physician oversight and lack of business management education. Continuing work to remove restricted and reduced state regulatory environments and to provide education on business management may increase the number of NPs in private practice, expanding access to health care in the United States.

1School of Nursing, University of Southern Maine, Portland, Maine

2Duquesne University School of Nursing, Pittsburgh, PA

3Lincoln Health Obstetrics, Damariscotta, Maine

Correspondence: Catherine Lyden, PhD, RN, FNP-C, CCRN, Assistant Professor, University of Southern Maine, School of Nursing, 96 Falmouth St, Portland, ME 04103; Tel: (207) 780-4508; E-mail:

Competing interests: The authors report no conflicts of interest.

Authors' contributions: C. Lyden: original research idea, manuscript development, and the primary and contact author. L.K. Sekula: mentor for idea development and design and substantial editing and review. B. Higgins: expertise as a business owner and reviewing and editing of the manuscript. R. Zoucha: review and editing of qualitative aspects of the manuscript.

Received May 08, 2017

Received in revised form September 30, 2017

Accepted October 17, 2017

© 2018 American Association of Nurse Practitioners
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