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Background: Primary care structural capabilities (i.e., electronic health records, care coordination, community integration, and reminder systems) can address the multiple needs of persons living with dementia (PLWD). Objectives: This study describes structural capabilities in primary care practices where nurse practitioners (NPs) provide care to PLWD and compares the presence of structural capabilities in practices with a high and low volume of PLWD. Methods: We conducted a secondary analysis of cross‐sectional data from 293 NPs in 259 practices in California. Logistic regression models were used to determine the association between the volume of PLWD and the presence of structural capabilities. Results: NPs reported that 96% of practices had electronic health records, 61% had community integration, 55% had reminder systems and 35% had care coordination capabilities. Practices with a high volume of PLWD were less likely to have community integration compared to practices with a low volume of PLWD. Conclusion: Many PLWD‐serving practices do not have the essential infrastructure for providing optimal dementia care. Practice managers should focus on implementing the essential structural capabilities to address the complex needs of PLWD. Implications for practice: Clinicians and practice administrations can use the findings of this study to improve the delivery of care in practices that provide care to PLWD. [ABSTRACT FROM AUTHOR]

Accurate in‐hospital mortality prediction can reflect the prognosis of patients, help guide allocation of clinical resources, and help clinicians make the right care decisions. There are limitations to using traditional logistic regression models when assessing the model performance of comorbidity measures to predict in‐hospital mortality. Meanwhile, the use of novel machine‐learning methods is growing rapidly. In 2021, the Agency for Healthcare Research and Quality published new guidelines for using the Present‐on‐Admission (POA) indicator from the International Classification of Diseases, Tenth Revision, for coding comorbidities to predict in‐hospital mortality from the Elixhauser's comorbidity measurement method. We compared the model performance of logistic regression, elastic net model, and artificial neural network (ANN) to predict in‐hospital mortality from Elixhauser's measures under the updated POA guidelines. In this retrospective analysis, 1,810,106 adult Medicare inpatient admissions from six US states admitted after September 23, 2017, and discharged before April 11, 2019 were extracted from the Centers for Medicare and Medicaid Services data warehouse. The POA indicator was used to distinguish pre‐existing comorbidities from complications that occurred during hospitalization. All models performed well (C‐statistics >0.77). Elastic net method generated a parsimonious model, in which there were five fewer comorbidities selected to predict in‐hospital mortality with similar predictive power compared to the logistic regression model. ANN had the highest C‐statistics compared to the other two models (0.800 vs. 0.791 and 0.791). Elastic net model and AAN can be applied successfully to predict in‐hospital mortality. [ABSTRACT FROM AUTHOR]

Primary care providers (PCPs) are well‐positioned to provide care for opioid use disorder (OUD), yet very few address OUD regularly. One contributing factor may be PCPs' lack of confidence in their ability to effectively treat OUD. Evidence demonstrates that clinician confidence in home care and hospital settings is associated with improved care delivery and patient outcomes. However, a conceptual definition of PCP confidence in addressing OUD has yet to be established. The aim of this concept analysis is to enhance conceptual understanding of PCP confidence in addressing OUD and inform future measurement strategies. Following Walker and Avant's method of concept analysis, PubMed, PsycINFO, and Google Scholar were searched in October 2021. Manuscripts were included if they referenced confidence in relation to PCPs who provide care to adult patients with OUD. Studies conducted outside the US and not published in English were excluded. The search resulted in 18 studies which were synthesized to conceptualize PCP confidence in addressing OUD. Defining attributes include self‐efficacy, experience, and readiness to address OUD. These attributes may be influenced by organizational culture, training, support, and resources. Consequences of PCP confidence addressing OUD may include improved patient outcomes, improved delivery of and access to OUD care, and PCP attitude changes. This concept analysis—which grounds the concept of PCP confidence in addressing OUD in the theoretical and empirical literature—lays the framework for future measurement of the concept. This represents a critical first step towards developing strategies to enhance PCP confidence in addressing OUD. [ABSTRACT FROM AUTHOR]

Nurse practitioner (NP) scope of practice (SOP) policies are different across the United States. Little is known about their impact on NP work environment in healthcare organizations. We investigated the association between SOP policies and organizational‐level work environment of NPs. Through a cross‐sectional survey design, data were collected from 1244 NPs in six states with variable SOP regulations (Arizona, New Jersey, Washington, Pennsylvania, Texas, and California) in 2018–2019. Arizona and Washington had full SOP—NPs had full authority to deliver care. New Jersey and Pennsylvania had reduced SOP with physician collaboration requirement; California and Texas had restricted SOP with physician supervision requirement. NPs completed mail or online surveys containing the Nurse Practitioner Primary Care Organizational Climate Questionnaire, which has these subscales: NP‐Administration Relations (NP‐AR), NP‐Physician Relations (NP‐PR), Independent Practice and Support (IPS), and Professional Visibility (PV). Regression models assessed the relationship between state‐level SOP and practice‐level NP work environment. NP‐AR scores were higher in full SOP states compared to reduced (β = 0.22, p < 0.01) and restricted (β = 0.15, p < 0.01) SOP states. Similarly, IPS scores were higher in full SOP states. The PV scores were also higher in full SOP states compared to reduced (β = 0.16, p < 0.001) and restricted (β = 0.12, p < 0.05) SOP states. There was no relationship between SOP and NP‐PR score. State‐level policies affect NP work environment. In states with more favorable policies, NPs have better relationships with administration and report more role visibility and support. Efforts should be made to remove unnecessary SOP restrictions. [ABSTRACT FROM AUTHOR]

Aims: To explore the relationship between nurse practitioner work environment and nurse practitioner outcomes (job satisfaction and intent to leave) in the United States. Design The study used a cross‐sectional survey design to collect survey data from primary care nurse practitioners in six states in the United States. Methods: We sent mail surveys to 5689 eligible nurse practitioners in Arizona, New Jersey, Washington, Pennsylvania, California and Texas. The mail also contained an online link. Participants could complete either the paper or online questionnaire. In total, 1244 participants completed the survey in 2018–2019. The work environment was measured using the Nurse Practitioner‐Primary Care Organizational Climate Questionnaire comprised of four subscales: Nurse Practitioner‐Administration Relations, Nurse Practitioner‐Physician Relations, Independent Practice and Support and Professional Visibility. Global items measured job satisfaction and intent to leave. We used mixed‐effect proportional‐odds cumulative logit models to assess the association between work environment and job satisfaction and intent to leave. Results: Overall, 90% of participants were either very satisfied or somewhat satisfied with their job and 22% reported intent to leave their job in 1 year. With a one‐unit increase in the organizational‐level Nurse Practitioner‐Administration Relations score, the odds of having a higher job satisfaction level increased by about four times and the odds of intent to leave job decreased by about 60%. A higher organizational‐level Nurse Practitioner‐Physician Relations score was significantly associated with higher job satisfaction and lower odds of intent to leave. Conclusion: Improvements in work environments may improve nurse practitioner job satisfaction and retention. Impact This study examined the relationship between work environment, job satisfaction and turnover intention of nurse practitioners. Better work environment is associated with higher job satisfaction and lower turnover intention. Findings have implications for clinical leadership who can take actions to create better work environments to increase the nurse practitioner workforce capacity. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to illustrate the relationship between nurse staffing and missed care, and how missed care affects quality of care and adverse events in Thai hospitals. Background: Quality and safety are major priorities for health care system. Nurse staffing and missed care are associated with low quality of care and adverse events. However, examination of this relationship is limited in Thailand. Methods: This cross‐sectional study collected data from 1188 nurses in five university hospitals across Thailand. The participants completed questionnaires that assessed the patient‐to‐nurse ratio, adequacy of staffing, missed care, quality of care and adverse events. Logistic regression models were used to estimate associations. Results: Higher patient‐to‐nurse ratio, poor staffing and lack of resource adequacy were significantly associated with higher odds of reporting missed care. Higher nurse‐reported missed care was significantly associated with higher odds of adverse events and poor quality of care. Conclusions: Poor nurse staffing was associated with missed care, and missed care was associated with adverse events and lower quality of care in Thai university hospitals. Implications for Nursing Management: Improving nurse staffing and assuring adequate resources are recommended to reduce missed care and adverse events and increase quality of care. [ABSTRACT FROM AUTHOR]

Background: New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. Purpose: To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. Methods: A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition–related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. Results: As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p =.007; β = −2.218; 95% confidence interval [CI]: −3.79 to −0.644 and p =.04; β = −2.698; 95% CI: −5.268 to −0.127, respectively). Implications for practice: Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Background: Prevalence of electronic health records (EHRs) has significantly increased, and EHRs are a known contributor to clinician burnout. However, it is unknown whether the use of multifunctional EHRs is associated with nurse practitioner (NP) burnout in primary care practices. This is a major gap in the literature because 69% of practicing NPs deliver primary care services to patients. Purpose: This study aimed to investigate whether the use of multifunctional EHRs is associated with primary care NP burnout. Method: This study is a secondary analysis of cross-sectional survey data collected from NPs in two states (Pennsylvania and New Jersey). Nurse practitioners completed surveys measuring burnout, use of multifunctional EHRs, demographics, and characteristics of their practice. Use of multifunctional EHRs was operationalized using two items—computerized capabilities and electronic reminder systems. Burnout was measured using a validated, single item asking NPs to self-report their feelings of burnout. A multilevel cox regression model was built to test for associations between the use of multifunctional EHRs and NP burnout. Results: Of 396 NPs included, 25.3% reported burnout. The use of multifunctional EHRs did not increase primary care NP burnout (risk ratio = 0.30, 95% confidence interval = 0.13–0.71, p =.01). Implications for practice: With 25.3% of NPs burned out, it is imperative to reduce NP burnout. However, computerized capabilities and electronic reminder systems did not contribute to feelings of NP burnout. Future research examining other EHR components is needed to understand which features of the EHR contribute to NP burnout. [ABSTRACT FROM AUTHOR]

Background: Burnout threatens patient care and clinicians are experiencing challenges within the practice environment. Little is known about nurse practitioner (NP) perceptions of burnout and its relationship to care quality and practice environment. We investigate the relationship between primary care NP burnout on perceptions of care quality and if the practice environment moderates the relationship between burnout and care quality. Methods: This is a secondary analysis of cross‐sectional survey data from 396 NPs. Burnout and care quality were measured using a single item, but the practice environment was measured using the Nurse Practitioner Primary Care Organizational Climate Questionnaire. Multi‐level proportional odds cumulative logit models were built to test for associations between burnout and care quality and for moderation. Results: Total, 25.3% of NPs reported burnout. Odds of perceiving higher quality of care was 85% less for NPs experiencing burnout compared to those not experiencing burnout. Practice environment did not moderate the relationship between burnout and care quality, but with a one unit increase in the practice environment subscales, the odds of NPs perceiving higher care quality increased anywhere from 3.83 to 7.57 times. Conclusion: Burnout is related to lower perceptions of care quality but favorable environments were related to higher perceptions of quality. [ABSTRACT FROM AUTHOR]

Nurses' health literacy knowledge and communication skills are essential for improving patients' health literacy. Yet, research on nurses' health literacy knowledge and perception is limited. The study aimed to evaluate nurses' health literacy knowledge, communication techniques, and barriers to the implementation of health literacy interventions. A cross‐sectional study was used, and a total of 1697 nurses in 104 community hospitals in Thailand completed self‐report measures. Approximately 55% of the participants had heard about the concept of health literacy; 9% had received formal training specific to interaction with patients with low health literacy. About 50% of the nurses were aware of their patients' low health literacy; therefore, they applied the recommended communication techniques for them. Delivery of effective health literacy training was hampered by a lack of assessment tools, health literacy training and specialists, educational materials, and health provider time. Hospital administrators, nurse managers, health leaders should develop strategies to create environments and resources supporting health literacy interventions. [ABSTRACT FROM AUTHOR]

Background: Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. Objective: We investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. Methods: A cross-sectional survey design was used to collect survey data from nurse practitioners (n = 398) in primary care practices in New York State in 2017. Nurse practitioners completed mail surveys with validated measures of organizational support, job satisfaction, intent to leave, and quality of care. Information on participant demographics and work characteristics was also collected. Multilevel regression models assessed the relationship between organizational-level organizational support and resources measure and job satisfaction, intent to leave, and quality of care. Results: The organizational-level organizational support and resources measure had a mean of 3.31 on a 4-point scale. Twentyfive percent of the participants were eithermoderately dissatisfied or very dissatisfied with their jobs, and about 11% intended to leave their current jobs within 1 year. The average quality of care rated by participants was 8.51 out of 10-10 being the best quality of care. After adjusting for covariates, higher organizational-level organizational support and resources measure score was associated with higher job satisfaction category, lower odds of intent to leave, and higher quality of care. Discussion: Nurse practitioners from primary care practices with higher levels of organizational support are more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care. Thus, in order to promote nurse practitioner job satisfaction, retain them in clinical positions, and improve quality of care, administrators should take actions to promote organizational support for them. Our findings are consistent with existing literature regarding the relationship between organizational support and clinician outcomes. [ABSTRACT FROM AUTHOR]

Background: Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important.Objective: We assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affects their job satisfaction, intent to leave their current job, and quality of care.Design: A cross-sectional survey design was used to collect data from both NPs and physicians in New York State in 2017.Participants: 584 participants (398 NPs and 186 physicians) from 476 primary care practices completed the survey yielding a 27% response rate for NPs and 12% for physicians.Main Measures: The survey tool contained validated measures of teamwork and three outcomes: job satisfaction, intent to leave, and perceived quality of care. Simple and multi-level multivariable regression models were built.Key Results: Most participants (76%) were either moderately satisfied or very satisfied with their job (NP sample: 75%; physician sample: 77%) and about 10% intended to leave their current job (NP sample: 11%; physician sample: 9%). The average perceived quality of care was the same across NP and physician samples with a mean of 8.5 on a 11 point scale. After controlling for confounders, a higher organizational-level teamwork score was associated with higher job satisfaction (cumulative OR: 3.00; 95% CI: 1.85-4.88), lower odds of intent to leave (OR: 0.25; 95% CI: 0.09-0.74), and higher perceived quality of care (b=1.00; 95% CI: 0.77-1.23).Conclusions: This study produced evidence about NP-physician teamwork in primary care practices. We found the vast majority of NPs and physicians reported favorable teamwork, and that teamwork affects clinician job satisfaction and intent to leave as well as perceived quality of care in their practices. [ABSTRACT FROM AUTHOR]

The article presents a systematic review that aims to determine the cost-effectiveness of chronic disease care provided by advanced practice nurses (APNs) compared to physicians globally. Topics mentioned include the global economic impact of chronic diseases by 2030, professional organizations that continued to debate whether APNs should be able to practice independently, and quality appraisal of all eligible studies using the Quality of Health Economic Studies instrument.

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Aim: This study investigated transformational leadership from the perspectives of primary care nurse practitioners. Background: The growing workforce of nurse practitioners in the United States could play a critical role in meeting the increasing demand for primary care. Little is known about how leadership within primary care practices could promote nurse‐practitioner care. Transformational leadership is a widely recognized leadership style that affects clinician practice and outcomes. Method: A cross‐sectional survey design was used to collect data from nurse practitioners in New York state in 2012. The online survey containing measures of nurse practitioners and leadership relationships was completed by 278 nurse practitioners. Results: The four factors of transformational leadership—idealized influence, inspirational motivation, intellectual stimulation, and individual consideration—were recognized by nurse practitioners. Almost half of nurse practitioners reported that leadership did not share information equally between nurse practitioners and physicians (idealized influence), and 45.9% reported that nurse practitioners were not represented on important organisational committees (intellectual stimulation). Conclusion: Transformational leadership can be applied to promote nurse practitioner practice in primary care. Future research should explore how transformational leadership affects nurse practitioner care and outcomes. Implications for Nursing Management: Leaders in primary care practices should consider applying transformational leadership principles to promote nurse practitioner practice. [ABSTRACT FROM AUTHOR]

Current demand for primary care services will soon exceed the primary care provider (PCP) workforce capacity. As patient panel sizes increase, it has become difficult for a single PCP to deliver all recommended care. As a result, provider comanagement of the same patient has emerged in practice. Provider comanagement is defined as two or more PCPs sharing care management responsibilities for the same patient. While physician–physician comanagement of patients has been widely investigated, there is little evidence about nurse practitioner (NP)–physician comanagement. Given the large number of NPs that are practicing in primary care, more evidence is warranted about the PCP perspectives of physicians and NPs comanaging patient care. The purpose of this study was to explore NP–physician comanagement in primary care from the perspectives of PCPs. We conducted in-person qualitative interviews of 26 PCPs, including NPs and physicians, that lasted 25 to 45 minutes, were audio recorded, and then professionally transcribed. Transcripts were deidentified and checked for accuracy prior to a deductive and inductive data analysis. Physicians and NPs reported that comanagement increases adherence to recommended care guidelines, improves quality of care, and increases patient access to care. Effective communication, mutual respect and trust, and a shared philosophy of care are essential attributes of NP–physician comanagement. Physicians and NPs are optimistic about comanagement care delivery and find it a promising approach to improve the quality of care and alleviate primary care delivery strain. Efforts to promote effective NP–physician comanagement should be supported in clinical practice. [ABSTRACT FROM AUTHOR]

The article discusses a study on the increased staffing of registered nurses (RN) within primary care in the U.S. The study obtained perspectives of primary care providers (PCPs) about the use of RNs in primary care. It examined the implementation of team-based care models to expand the access to primary care, reduce cost and improve health care quality.

Background and purpose: In 2015, New York State adopted the Nurse Practitioners Modernization Act to remove required written practice agreements between physicians and nurse practitioners (NPs) with at least 3,600 hours of practice experience. We assessed the perspectives of physicians and NPs on the barriers and facilitators of policy implementation. Methods: Qualitative descriptive design and individual face-to-face interviews were used to collect data from physicians and NPs. One researcher conducted interviews, which were audio-taped and transcribed. Twenty-six participants were interviewed. Two researchers analyzed the data. Results: The new law has not yet changed NP practice. Almost all experienced NPs had written practice agreements. Outdated organizational bylaws, administrators' and physicians' lack of awareness of NP competencies, and physician resistance and lack of knowledge of the law were barriers. Collegial relationships between NPs and physicians and positive perceptions of the law facilitated policy implementation. Conclusions: Policy makers and administrators should make efforts to remove barriers and promote facilitators to assure the law achieves its maximum impact. Implications for practices: Efforts should be undertaken to implement the law in each organization by engaging leadership, increasing awareness about the positive impact of the law and NP independence, and promoting relationships between NPs and physicians. [ABSTRACT FROM AUTHOR]

Purpose: Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement.Methods: We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model.Results: Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians.Conclusions: Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. [ABSTRACT FROM AUTHOR]

The growing nurse practitioner (NP) workforce represents a significant supply of primary care providers, who if optimally utilized, are well-positioned to improve access to health care for racial and ethnic minorities. However, many barriers affect the optimal utilization of NPs in primary care delivery. These barriers may also prevent NPs from maximally contributing to efforts to reduce racial and ethnic health disparities. Our review of the empirical and health policy literature sought to elucidate factors that affect NPs’ potential and ability to narrow or eliminate health disparities. We found that restrictive state scope of practice regulations, disparate reimbursement policies, lack of NP workforce diversity, and poor organizational structures in NP practices may limit NPs’ contributions to current efforts to reduce disparities. Our results led to the development of the nurse practitioner health disparities model which identifies barriers to and opportunities for optimal use of NPs in reducing racial and ethnic disparities. State and federal policymakers and administrators in health-care settings should take actions to remove legislative and organizational barriers to enable NPs to deliver high-quality care to racial and ethnic minorities. Researchers can use the nurse practitioner health disparities model to produce empirical evidence to reduce health disparities and improve population health. [ABSTRACT FROM AUTHOR]

Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic impact as important. Practice and policy change addressing these factors is needed for effective interprofessional teamwork. [ABSTRACT FROM AUTHOR]

Background: The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians.Objective: We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians.Design: Using a cross-sectional survey design, data was collected from 163 primary care practices in Massachusetts.Participants: Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %.Main Measures: The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale.Key Results: The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model.Conclusion: The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to investigate the effect of nurse burnout on nurse-reported quality of care and patient adverse events and outcomes in Thai hospitals. Methods Cross-sectional analysis of data from 2,084 registered nurses working in 94 community hospitals across Thailand. Data were collected through survey questionnaire, including the Maslach Burnout Inventory (MBI), which measures of nurse perceived quality of care and patient outcomes. Multiple logistic regression modeling was performed to explore associations between nurse burnout on quality of care and patient outcomes. Findings Thirty-two percent of nurses reported high emotional exhaustion, 18% high depersonalization, and 35% low personal accomplishment. In addition, 16% of nurses rated quality of care on their work unit as fair or poor, 5% reported patient falls, 11% reported medication errors, and 14% reported infections. All three subscales of the MBI were associated with increased reporting of fair or poor quality of care, patient falls, medication errors, and infections. Every unit of increasing emotional exhaustion score was associated with a 2.63 times rise in reporting fair or poor quality of care, a 30% increase in patient falls, a 47% increase in medication errors, and a 32% increase in infection. Conclusions Findings clearly indicate that nurse burnout is associated with increased odds of reporting negative patient outcomes. Implementing interventions to reduce nurse burnout is critical to improving patient care in Thai hospitals. Clinical Relevance Hospital administrators, nurse managers, and health leaders urgently need to create favorable work environments supporting nursing practice in order to reduce burnout and improve quality of care. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Aims and objectives. The purpose of this qualitative descriptive study was to explore the views of head and staff nurses about nursing practice in the hospitals of Armenia. Background. Armenia inherited its nursing frameworks from the Soviet Union. After the Soviet collapse, many changes took place to reform nursing. However, to date little has been systematically documented about nursing practice in Armenia. Design. Qualitative descriptive design was implemented. Methods. Three major hospitals in Yerevan, the capital city of Armenia, participated in the study. Purposeful sampling was used. Forty-three nurses participated, 29 staff and fourteen head nurses. Data were collected through five focus groups comprised of seven to ten participants. A focus group guide was developed. The researcher facilitated the discussions in Armenian, which were audio taped. The research assistant took notes. Data were transcribed and translated into English, imported into atlas.ti 6.1 qualitative software, and analysed by three authors. Results. Five themes were extracted. Lack of role clarity theme was identified from the head nurse data. The practice environment theme was identified from the staff nurse data. Nursing education, value, respect and appreciation of nursing, and becoming a nurse were common themes identified from both head and staff nurse data. Head nurses lack autonomy, do not have clear roles and are burdened with documentation. Staff nurses practice in challenging work environments with inadequate staffing and demanding workloads. All nurses reported the need to improve nursing education. Conclusions. This is the first study conducted in Armenia exploring nursing practice in the hospitals from the nurses' perspectives. Nurses face challenges that may impact their wellbeing and patient care. Relevance to clinical practice. Understanding challenges nursing practice faces in the hospitals in Armenia will help administrators and care providers to take actions to improve nursing practice and subsequently patient care. [ABSTRACT FROM AUTHOR]