Advanced Practice Nursing Models of Care: Results from a National United States Survey

Overview: Advanced Practice Nurses (APNs) including nurse practitioners (NP)  are an increasingly important component of the nation’s healthcare workforce.   Although the NP role is an established one, there remains limited information on the specific care models across the diverse hospital and clinic settings within healthcare systems.  This information is crucial in order to objectively evaluate the effectiveness of APN roles – data that is currently lacking.  To address this gap, a national survey was conducted targeting NPs working in hospital and clinic settings.

Aim: Describe the types of NP models of care currently in use in hospital and clinic practice settings.    

Methods: Focus groups of 26 nurses from 8 US states was conducted to inform revision of a national survey used in a prior 5 year longitudinal survey of NPs. The 34 item survey addresses 4 domains including role components (i.e. direct care management; care coordination; performing procedures; education; quality assurance; research); role responsibilities (i.e. practice autonomy, prescriptive authority, credentialing and privileging delineations) unit-level organization (i.e. physician staffing models,  components of the multidisciplinary care team); and hospital organization (i.e. academic status, bed size, location, payer-mix). An online survey was distributed to NPs who were members of a national NP organization and an international multiprofessional organization

Results: 1350 NPs responded to the national survey and reported working in a variety of settings including hospitals, clinics, urgent care centers and specialty practice sites. Main role components included patient care management, teaching to patients, families and healthcare staff; involvement in quality improvement and research initiatives and administrative components such as committee work. Specific aspects include conducing history & physical exams ordering and interpreting diagnostic test/labs; providing care coordination, performing specialty procedures such as wound care or other specialty care. Major areas of impact that were identified included continuity of care, improving evidence based practice care, reducing hospital length of stay, preventing hospital readmissions and promoting patient, family and staff satisfaction.

Implications: The results of the study provide information from a large national sample of NPs that identifies the comprehensive care components of the role as well as areas of impact, highlighting the value of APN care.

Acknowledgement: Funding from the American Association of Critical Care Nurses Impact Grant is gratefully acknowledged