Paper
Friday, July 13, 2007
Using the Primary Provider Theory to Measure Nurse Practitioners Effect on Patients' Satisfaction, Ratings of Care, and Likelihood to Recommend a Practice
Stephen J. Aragon, PhD, MHA, BS1, Stephanie Pickett, MSN, BSN2, and Sheigethia Edwards, MSN, BSN2. (1) School of Health Sciences- Department of Nursing, Winston-Salem State University, Winston-Salem, NC, USA, (2) The School of Health Sciences, Department of Nursing, Winston-Salem State University, Winston-Salem, NC, USA
PURPOSE: The purpose of this investigation was to measure the influence of nurse practitioners patient-centeredness on patients’ satisfaction, their ratings of care, and their likelihood to recommend the medical practice, and secondly, to test the robustness of the Primary Provider Theory and its effects across two national random samples of nurse practitioner patients. METHODS: Specified according to the Primary Provider Theory, a four-factor multigroup structural equation modeling design was used, with cross-group equality constraints to test the Theory’s measurement robustness across samples. The hypothesized model was also compared with a competing model. RESULTS: The Theory fit the patient data well, demonstrating that nurse practitioners patient-centeredness significantly influenced overall patient satisfaction, explaining 77 percent of its variance. Nurse practitioners also significantly influenced patient’s ratings of care and their likelihood of recommending the practice. When satisfaction with the nurse practitioners increased by one unit, the values for overall satisfaction improved by .890 units (.807 standardized), ratings of care by .890 units (.783 standardized), and the likelihood to recommend by .893 units (.732 standardized). Nurse practitioners’ patient-centered concern for their patient’s questions and worries and inclusion of patients in decisions increased satisfaction with nurse practitioners, which correspondingly increased satisfaction with waiting time, other nursing service, and overall clinic satisfaction. This pattern of effects held across both samples of patients as predicted by the Theory, and the hypothesized model was sustained when compared with the competing model. DISCUSSION: The Primary Provider Theory offers a paradigm for measuring and improving patient-centeredness, patient satisfaction, ratings of care, and the likelihood of recommending the practice, when the provider is a nurse practitioner. The results of this investigation have implications for nurse practitioners, evidence-based outcome measurement, patient-centered care and satisfaction, patient-provider relationships, and nursing education.