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Background: Retaining nurse practitioners (NPs) from diverse racial and ethnic groups is critical to achieving health equity as NPs disproportionately care for minoritized populations. Yet, little is known about intent to leave (ITL) among these NPs., Purpose: To examine whether NP race and ethnicity were associated with ITL and if this relationship was affected by the work environment., Methods: Survey data from 1,232 NPs across six states were used. NPs completed measures of their ITL, work environment quality, and demographics. Regression models were used to determine if NP race and ethnicity resulted in differential reports of ITL., Findings: Minoritized NPs had significantly higher cumulative odds of ITL compared with White NPs., Discussion: Minoritized NPs had higher ITL, and the work environment did not demonstrate a protective effect against ITL. Future research should identify work environment features that may help retain a diverse NP workforce., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024. Published by Elsevier Inc.)

Background: Nurse practitioners (NPs) can enhance NP care and improve access to care by autonomously managing their patient panels. Yet, its impact on workforce outcomes such as burnout, job satisfaction, and turnover intention remains unexplored., Purpose: To estimate the impact of NP panel management on workforce outcomes., Methods: Structural equation modeling was conducted using survey data from 1,244 primary care NPs. NP panel management was categorized into co-managing patients with other providers, both co-managing and autonomously managing, and fully autonomous management., Discussion: Fully autonomous management led to more burnout than co-managing (B = 0.089, bias-corrected 95% bootstrap confidence interval [0.028, 0.151]). Work hours partially (27%) mediated this relationship. This findings indicate that greater autonomy in panel management among NPs may lead to increased burnout, partially due to longer work hours., Conclusion: Interventions to reduce work hours could help NPs deliver quality care without burnout., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice., Method: We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize., Results: The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias., Discussion: Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity., Competing Interests: CONFLICT OF INTEREST None to report. The authors wish to acknowledge John Usseglio, an informationist at Columbua University, for their assistance with developing the search strategy., (Copyright © 2023 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: Primary care delivered by nurse practitioners (NPs) helps to meet the United States' growing demand for care and improves patient outcomes. Yet, barriers impede NP practice. Knowledge of these barriers is limited, hindering opportunities to eliminate them., Purpose: We convened a 1.5-day conference to develop a research agenda to advance evidence on the primary care NP workforce., Methods: Thirty experts gathered in New York City for a conference in 2022. The conference included plenary sessions, small group discussions, and a prioritization process to identify areas for future research and research questions., Discussion: The research agenda includes top-ranked research questions within five categories: (a) policy regulations and implications for care, quality, and access; (b) systems affecting NP practice; (c) health equity and the NP workforce; (d) NP education and workforce dynamics, and (e) international perspectives., Conclusion: The agenda can advance evidence on the NP workforce to guide policy and practice., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The nurse practitioner (NP) workforce is key to meeting the demand for mental health services in primary care settings., Purpose: The purpose of this study is to synthesize the evidence focused on the effectiveness of NP care for patients with mental health conditions in primary care settings, particularly focused on primary care NPs and psychiatric mental health NPs and patients with anxiety, depression, and substance use disorders., Methods: Studies published since 2014 in the United States studying NP care of patients with anxiety, depression, or substance use disorders in primary care settings were included., Findings: Seventeen studies were included. Four high-quality studies showed that NP evidence-based care and prescribing were comparable to that of physicians. Seven low-quality studies suggest that NP-led collaborative care is associated with reduced symptoms., Discussion: More high-quality evidence is needed to determine the effectiveness of NP care for patients with mental health conditions in primary care settings., Competing Interests: Declaration of Competing Interest None to report., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Many professional nursing organizations have proposed that the Doctor of Nursing Practice (DNP) is the most appropriate entry-level degree for nurse practitioners (NPs). There have been no studies to date examining the impact of DNP preparation on quality of care or patient outcomes., Purpose: To examine differences in emergency department utilization and hospitalizations among patients with chronic conditions cared for by Master of Science in Nursing (MSN)- and DNP-prepared primary care NPs., Methods: We use survey data from over 1,000 primary care NPs in 6 states linked to Medicare claims data. Using regression models, we controlled for various patient, NP, and practice characteristics that might confound the relationship., Resuls: We find that patient outcomes are not statistically different between patients attributed to MSN- and DNP-prepared primary care NPs., Discussion: These findings suggest that there remains little evidence that DNP education has led to significant improvements in patient outcomes., Conclusions: Further empirical analysis related to the clinical outcomes other than health care utilization of the DNP degree is warranted. Future studies might consider examining (a) NPs in settings other than primary care, (b) practice-wide or system-wide outcomes, (c) other measures of care quality, and (d) impact of DNP program content., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: The growing nurse practitioner (NP) workforce plays a critical role in primary care delivery in the United States. However, better recruitment and retention of the robust NP workforce in underserved areas are needed; evidence to inform such effort is limited., Purpose: This scoping review aimed to examine the findings, scope, and knowledge gaps of available literature on factors associated with NP recruitment and retention in underserved areas., Methods: This review was guided by Joanna Briggs' Scoping Review Methodology and PRISMA-SCR reporting standards. Literature search for peer-reviewed and gray literature was conducted in six databases., Findings: A total of 22 studies met inclusion criteria. Factors associated with NP recruitment and retention in underserved areas were mapped into five themes, including factors related to: the individual NP, NP education programs/financial aid, organizations employing NPs, the communities NPs work in, and autonomous practice. Majority of the included studies were published before 2010; few used rigorous study designs and analysis methods; and few exclusively studied NPs and unique challenges facing the NP workforce., Discussion: Available studies demonstrate that NP recruitment and retention can be addressed by various stakeholders (e.g., educators, policy makers); however, up-to-date, methodologically rigorous, and NP-focused studies are needed., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This policy paper reviews the history, use and significance of telehealth in primary care. The emergence of telehealth as a primary strategy to continue to deliver value based, timely primary care during COVID-19 is discussed with recommendations for future applications, payment and preparation of providers to continue to provide quality care of clients in the future using telehealth., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: During the COVID-19 pandemic, federal and state governments removed the scope of practice restrictions on nurse practitioners (NPs), allowing them to deliver care to patients without restrictions., Purpose: To support policy makers' efforts to grant full practice authority to NPs beyond the COVID-19 pandemic, this manuscript summarizes the existing evidence on the benefits of permanently removing state-level scope of practice barriers and outline recommendations for policy, practice, and research., Methods: We have conducted a thorough review of the existing literature., Findings: NP full scope of practice improves access and quality of care and leads to better patient outcomes. It also has the potential to reduce health care cost., Discussion: The changes to support full practice authority enacted to address COVID-19 are temporary. NP full practice authority could be part of a longer-term plan to address healthcare inequities and deficiencies rather than merely a crisis measure., (Copyright © 2021. Published by Elsevier Inc.)

Background: Many nursing schools are adopting the Doctor of Nursing Practice (DNP) as the preferred model of nurse practitioner (NP) education and eliminating Master of Science in Nursing (MSN) programs. To date, no studies have explored the relationship between DNP preparation and NP practice environment, independence, and roles., Purpose: The purpos of this study is to compare practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs., Methods: This study used a cross-sectional design and observational regression analysis of survey data., Findings: DNP-prepared NPs reported: 1) more favorable NP-Physician Relationships, 2) fewer clinical hours, and 3) more practice leadership. These differences were, however, small and not significant at 0.05 level., Discussion: We found no major differences in practice environment, independence, and roles among DNP- and MSN-prepared primary care NPs. As more nursing schools establish DNP programs and more DNP-prepared NPs enter the field, it is especially important to continue to study the impact of DNP preparation on the NP workforce., (Copyright © 2021. Published by Elsevier Inc.)

Background: Primary care practices employing nurse practitioners (NPs) can play an important role in improving access to high quality health care services. However, most studies on the NP role in health care use administrative data, which have many limitations., Purpose: In this paper, we report the methods of the largest survey of primary care NPs to date., Methods: To overcome the limitations of administrative data, we fielded a cross-sectional, mixed-mode (mail/online) survey of primary care NPs in six states to collect data directly from NPs on their clinical roles and practice environments., Findings: While we were able to collect data from over 1,200 NPs, we encountered several challenges with our sampling frame, including provider turnover and challenges with identification of NP specialty., Discussion: In future surveys, researchers can employ strategies to avoid the issues we encountered with the sampling frame and enhance large scale survey data collection from NPs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: In January of 2015, New York (NY) implemented a new policy, Nurse Practitioners Modernization Act, which removed the required written practice agreement between physicians and experienced nurse practitioners (NPs)., Purpose: We examined NP work environment in NY before (2012) and after (2018) the implementation of the new policy., Methods: Cross-sectional survey data on work environments were collected from NPs in NY in 2012 and 2018. Work environment was measured with the Nurse Practitioner Primary Care Organizational Climate Questionnaire. In 2012, 278 and in 2018, 348 NPs completed the tool. Regression analyses were used to examine the relationship between the study year and work environment., Findings: Controlling for individual and organizational characteristics, NPs reported significantly better work environments in 2018. Positive changes were observed both for experienced and less experienced NPs., Discussion: Removing state-level policy restrictions on NPs may promote a better work environment within health care organizations., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Given the projected increase in the nurse practitioner (NP) workforce, the number of NPs in health care organizations will grow. However, little is known about the capacity of these organizations to create conducive environments for NP practice., Purpose: Examine and compare the NP patient panel, job satisfaction, turnover intentions, and organizational structures of NPs with less than three (newly hired) and more than three (experienced) years of experience in their current job., Methods: An online survey of New York State Nurse Practitioner Association members was conducted in 2012; 278 NPs completed measures of NP patient panel, job satisfaction, turnover intentions, and organizational structures., Discussion: Both newly hired and experienced NPs faced organizational challenges such as poor relations with administration and lack infrastructure for care. Newly hired NPs were twice more likely to have turnover intentions., Conclusion: These organizational barriers should be addressed by administrators to assure optimal NP practice., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care., Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact., Method: We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes., Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes., Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Home health care (HHC) has been the fastest growing health care sector for the past 3 decades. The uncontrolled home environment, increased use of indwelling devices, and the complexity of illnesses among HHC patients lead to increased risk for infections., Methods: A systematic review of studies evaluating infection prevalence and risk factors among adult patients who received HHC services was conducted and guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Literature was searched using Medline, PubMed, and the Cumulative Index to Nursing and Allied Health as well as hand searching. Two reviewers independently assessed study quality using validated quality assessment checklists., Results: Twenty-five studies met the inclusion criteria and were reviewed. The infection rates and identified risk factors for infections varied dramatically between studies. In general, patients receiving home parental nutrition treatments had higher infection rates than patients receiving home infusion therapy. The identified risk factors were limited by small sample sizes and other methodologic flaws., Conclusions: Establishing a surveillance system for HHC infections, identifying patients at high risk for infections, tailoring HHC and patient education based on patient living conditions, and facilitating communication between different health care facilities will enhance infection control in HHC settings. Future studies should use a nationally representative sample and multivariate analysis for the identification of risk factors for infections., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)