Working Conditions Reported by Pediatric Nurse Practitioners in Hospital Practice

Abstract

Emerging Knowledge for Clinical Practice Podium Presentations focusing on the Research Agenda Priority of Role and Practice Issues, Presented at NAPNAP’s 37th National Conference on Pediatric Healthcare, March 17, 2016, Atlanta, GA Nearly a quarter of pediatric nurse practitioners (PNP) practice in hospital-based settings. The hospital-based PNP workforce is expected to grow in response to pediatric hospital provider demand. Care roles and skill utilization for PNPs in hospital-based practice differ from those in other settings. Inter-provider relationships and team based care models may introduce complexities that impact the working conditions for PNPs in hospitals. An important consideration when evaluating the extent of hospital-based services provided by PNPs are the implications of state scope-of-practice (SSoP) regulations and hospital and physician restrictions. It is imperative that PNPs practice to the full extent of their legal abilities to optimize patient access to pediatric care. Evaluating the effects of current restriction upon hospital-based PNPs’ ability to provide pediatric health care can facilitate changes that maximize PNPs’ utilization and contributions to pediatric care. to evaluate how work conditions influence pediatric nurse practitioner skill utilization and ability to practice to the fullest extent of SSoP in hospital-based settings. Secondary data analysis used the National Sample Survey of Nurse Practitioner 2012 dataset. This dataset was generated via a national survey mailed to a representative population of NPs (60.1% response rate). PNPs who reported primary clinical practice in the hospital were selected for analysis (N=414). Associations of working conditions with pediatric nurse practitioner skill utilization and restrictions to practice were evaluated using Pearson Chi-Square Tests of Independence. Of respondents, 79% (95% C.I., 76.1-82.7) believed their NP skills were being fully utilized and nearly 82% (95% C.I., 78.65-84.95) indicated practicing to the fullest extent of SSoP. PNPs who reported that both their skills were being fully utilized also were more likely to state that they were allowed to practice to the fullest extent of their SSoP (p<0.001). Nurse practitioners were more likely to agree that they were using their skills and practicing to the fullest extent of the SSoP if their relationship with physicians was one of equal colleagues (p<0.001) and they were able to bill using their own NPI (p=0.008). They were less likely to agree with that statement if they had a hierarchical/supervisory relationship with the physicians (p<0.001). No statistically significant associations were observed between skill utilization and reports of being allowed to practice to the full SSoP (p=0.532) or time physicians were in the hospital (p=0.194). Hospital-based PNPs report differences in skill utilization and ability to practice to the full extent of SSoP associated with the type of relationships they have with physicians. Practicing to the fullest extent of SSoP is associated with reports of optimal skill utilization.