Satisfaction With Practice in a Rural State: Perceptions of Nurse Practitioners and Nurse Midwives

Data from nurse practitioners and certified nurse midwive are used to explore contributions to primary care in a rural state and how regulatory restrictiveness and other factors affect satisfaction with practice ( N = 151). Satisfaction is high, especially with home communities and professional aspects of work, including collaboration with physicians. However, many feel limited by regulations and are less satisfied, especially those with a master's degree and those in organizational versus office practice sites. Reducing restrictive regulations, reevaluating practice structures, and providing for full scope of practice and other incentives consistent with rising educational levels can increase access to care.     

Transition Experiences of New Rural Nurse Practitioners

Nurse practitioners (NPs) make up the most rapidly expanding primary care workforce and are being utilized to meet the increased demand for primary care in rural settings. The researcher explored 10 registered nurses’ perceptions of their experiences while transitioning to their NP identities and first year of primary care practice in rural healthcare settings. The Rural Nurse Practitioner Transition and Professional Identity Development Model emerged. Critical to the NP’s successful transitions were an incentive to learn, a passion to work in rural healthcare, and the relationships with their patients, nurses, and other providers at the rural healthcare facilities and communities.     

Perceptions of Nurse Practitioners as Clinical Leaders in the Military

Health care systems need leaders to address complex challenges. This presents an opportunity for nurse practitioners (NPs). The United States Army is already using NPs as leaders. This study addresses the following 2 research questions: What are Army primary care clinicians’ perceptions of NPs as clinical leaders? and Are there differences in these perceptions? In this study, we used a survey that captured clinicians’ perceptions of NP leadership. Overall, respondents favored NPs as clinical leaders. Over 65% agreed that NPs were qualified as leaders within the Army. This study suggests clinicians perceive NPs as qualified and effective leaders at high levels throughout primary care.     

Electronic Health Records: Patient Care and Ethical and Legal Implications for Nurse Practitioners

Electronic health records (EHRs), with their adoption incentivized as part of the American Recovery and Reinvestment Act of 2009, are now a ubiquitous part of the health care landscape. Although these systems promised to improve the quality of patient care, increase efficiency, and reduce costs, health care providers are finding that current EHRs instead require time-consuming data entry, can interfere with patient interactions, and cause medical errors. Nurse practitioners should implement practical tips and best practices for navigating and successfully using EHRs, as well as risk management strategies to ensure better patient care and avoid malpractice litigation or licensing issues.     

Tertiary Nurse Practitioners

Tertiary nurse practitioners are proposed to meet the specialized health care needs of complex patients. Societal changes, increasing numbers of medically vulnerable people and increased costs of health care demand innovative responses to health care delivery. Nurse practitioners' effectiveness in primary care settings supports their introduction into acute care settings. Nurse practitioners are involved in tertiary care in response to a need for the delivery of care to patients with specialized needs. The evolution of the tertiary nurse practitioner role pre-dated the response of educational institutions to provide appropriate preparation for practitioners in tertiary care. Curricular imperatives and policy issues that will influence professional practice of the tertiary nurse practitioner are discussed .     

Patterns of Practice of Nurse Practitioners in an Undeserved Rural Region

An evaluation study explored the impact that graduates from a certificate-level nurse practitioner (NP) program had on rural health care in a large geographic region. Seven years produced 116 NPs, 85 (73 %) of which comprised the study sample. Variables measured included employment rates, practice settings, patient case load, impact on care, role acceptance, and role development. A survey design with a validated questionnaire was employed. Data showed a group involved in hands-on practice mainly to high-risk groups. Eighty-seven percent were subjects employed as NPs mainly in community health agencies. Of those 11 not employed, the main reason cited was personal choice of another nursing role, whereas choice of the NP position itself was based on the location of employment. NP skills/competencies were broken down according to taking of histories and physical, management, counseling, and referral; time allotted to each was proportioned. Findings also point to a strong tendency for continued study among graduates: 27 % of sample subjects were enrolled for a degree; 26 % sought further American Nurses' Association certification. Practice variables such as site, salary, patient case load, collaboration with backup physician, administrative structure, and acceptance of role were investigated and described. Results revealed that the NPs felt that the major contributions of their presence in practice were the increasing of the number of patient/clients with access to care and the providing of services to high-risk and disenfranchised consumer groups.     

Professionalism of Nurse Practitioners

Little information is presently available about the professionalism of nurse practitioners (NPs). Nor do we know what degree of professionalism is actually exhibited by NPs. Nurse practitioners in this study scored moderately professional. The highest level of education attained had no relationship to degree of professionalism. With increasing age and number of years in practice, NPs expressed a greater degree of professionalism. Nurse practitioners need to continue their development of professionalism, both as individuals and as members of groups and/or organizations. Recommendations for practice, education, and research are discussed.     

Advance Directives: Role of Nurse Practitioners

Advance directives are documents that guide end of life decisions. Although advance directives are a fairly recent phenomenon in health care, they are grounded in both legal and ethical principles. Studies show few people have completed advance directives. Persons do not tend to complete advance directives for various reasons. Lack of knowledge has been identified, as well as belief that physicians should initiate the discussion and that the topic is appropriate only for the elderly or those in poor health. Many nurse practitioners practice in primary care settings, which are ideal for discussions about advance directives. Nurse practitioners possess the opportunities and skills to discuss advance directives with their patients.     

Developing Professions Nurse Practitioners

In human medicine, the arrival of the independent nurse practitioner is raising questions about where the boundaries lie between the roles of nurses and doctors. Some of the resulting arguments about whether or not to expand the nurse's role may strike a chord with veterinary nurses. Zoe Berry, herself a nurse practitioner, provides food for thought for anyone watching developments in the veterinary nursing profession     

Nurse Practitioners: Need for and Willingness to Hire as Viewed by Nurse Administrators, Nurse Practitioners, and Physicians

The problem investigated in this project was the identification of need for and desire to hire nurse practitioners in a rural western state. Participants included licensed nurse practitioners, nurse administrators of licensed agencies, and licensed physicians in the state of Nevada. The survey examined the participant groups' views of the need for and their desire to hire nurse practitioners. The findings showed differences among the groups in relation to their education levels and whether they were practicing in rural or urban areas. The most pronounced finding was the indicated need for more information related to the role and functions of nurse practitioners before hiring them. Recommendations for future study are also included.     

Post-Cures Act: Implications for Nurse Practitioners

The Cures Act of April 2021, gives the public full and immediate access to their medical records in 8 different categories, with 2 exemptions: civil and criminal suits and administrative actions and psychotherapy session notes. There is language prohibiting an individual or organization from blocking this access. This article examines how this legislation impacts nurse practitioners building on and expanding their relationship with their patients and how critical it is that patients become full participating members in their care. The level of patient engagement and their activation as partners are critical for patients to fully benefit from this increased access. Obstacles to increasing patient engagement include low health and computer literacy of patients, providers not encouraging their patients to become active in their care, system-related barriers, such as the organization having other priorities than increasing patient engagement, and community factors to include media that do not address cultural aspects. Nurse practitioners need to continue to maintain a positive, respectful, and supportive milieu in which the patient, the family, and health care team function in a partnership, one in which there is shared decision making with the patient at the center, encouragement of portal usage, and dealing with health and computer literacy and any other barriers to developing this partnership.     

Population Aging: Implications for Nurse Practitioners

Population aging has occurred as a result of increased longevity throughout the lifespan coupled with declining birth rates. In the practice arena this demographic shift will increase the need for health services focused on chronic disease, comorbid status, and the unique health promotion for older adults. Nurse practitioner programs and continuing education providers must strengthen content on geriatrics and chronic disease management. Research on health care needs and care outcomes of older adults must increase. Nurse practitioners can best position themselves for this demographic shift by increasing their knowledge about health care needs of older adults.     

Nurse Practitioners: Reevaluation of the Need for and Willingness to Hire by Nurse Administrators, Nurse Practitioners, and Physicians

A survey of all nurse administrators and advanced practice nurses and a simple random sample survey of licensed physicians in Nevada were completed to reevaluate the perceived need for and willingness to hire nurse practitioners (NPs). The reevaluation was deemed necessary based on a similar survey that was completed by these authors in 1990. At that time significant questions were raised concerning the lack of understanding of the role of NPs in and their contribution to the health care team.
The results of the study clearly indicate that the unique contributions of the NP to the health care team should be further publicized and clarified. In addition, for some physicians, a significant disparity continues to exist between the optimal, collaborative role and the more readily accepted dependent role of the NP. The family NP (FNP) continues to be the most desired specialty for those who hire NPs.