A lack of nurse autonomy impacts population health when compared to physician care: an ecological study

Abstract

This study highlights that the contribution of nursing is secondary to physicians in overall population health (indexed with life expectancy at birth, e(0)). Scatter plots, bivariate correlation and partial correlation models were performed to analyse the correlations between e(0) and physician healthcare and nursing healthcare respectively. Affluence, urbanization and obesity were incorporated as the potential confounders. The Fisher’s r-to-z transformation was conducted for comparing the correlations. Multiple linear regression analyses were implemented for modelling that physicians’ contributions to e(0) explain nurses’. Nursing healthcare correlated to e(0) significantly less strongly than physician healthcare in simple regressions. Nursing healthcare was in weak or negligible correlation to e(0) when physician healthcare was controlled individually or together with the three confounders. Physician healthcare remains significantly correlational to e(0) when nursing healthcare alone was controlled or when the three confounders were controlled. Linear regression revealed that nursing healthcare was a significant predictor for e(0) when physician healthcare was “not added” for modelling, but this predicting role became negligible when physician healthcare was “added”. Our study findings suggested that nurses still work under the direction of physicians due to lack of autonomy. Without correction, health services will continue to transmit the invisibility of nursing healthcare from one generation of nurses to another.