ARNP scope of practice in FL

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Optimizing full scope of practice for nurse practitioners in primary care: A proposed conceptual model

Lusine Poghosyan, PhD, MPH, RN, FAANa,*, Donald R. Boyd, MPhil, MS, CRNAa, Sean P. Clarke, PhD, RN, FAANb

aColumbia University School of Nursing, New York, NY bConnell School of Nursing, Boston College, Chestnut Hill, MA

a r t i c l e i n f o

Article history: Received 7 May 2015 Revised 23 October 2015 Accepted 9 November 2015 Available online 23 November 2015

Keywords: Primary care Nurse practitioner Conceptual model

* Corresponding author: Lusine Poghosyan, C E-mail address: lp2475@columbia.edu (L.

0029-6554/$ – see front matter � 2016 Elsevi http://dx.doi.org/10.1016/j.outlook.2015.11.015

a b s t r a c t

Background: Nurse practitioners (NPs), if utilized to their optimal potential, could play a key role in meeting the growing demand for primary care. Purpose: The purpose of this study was to propose a comprehensive model for maximizing NP contributions to primary care which includes the factors affecting NP care and patient outcomes and explains their interrelated impact. Method:We synthesized the results of the published literature to develop a model, which emphasizes NP scope of practice regulations, institutional policies, NP practice environment, and NP workforce outcomes as determinants of NP care and patient outcomes. Discussion: Our model provides a framework to help explain how variations in scope of practice regulations at the state-level and institutional policies within organizations directly and indirectly influence the practice environment of NPs, NP workforce outcomes, and patient care and outcomes. Conclusion: Aligning policy change, organizational innovations, and future research are critical to NP optimal utilization and patient care and outcomes.

Cite this article: Poghosyan, L., Boyd, D. R., & Clarke, S. P. (2016, APRIL). Optimizing full scope of practice

for nurse practitioners in primary care: A proposed conceptual model. Nursing Outlook, 64(2), 146-155.

http://dx.doi.org/10.1016/j.outlook.2015.11.015.

Introduction

The U.S. health care system is at a vital crossroads in regards to health care workforce planning because of the aging population and rising prevalence of chronic illnesses (DeVol & Bedroussian, 2007; Institute of Medicine, 2012). In addition to these strains on the system, the enactment of the Affordable Care Act (ACA) has allowed millions of Americans who were previously uninsured to obtain health insurance and gain better access to health care services (Patient

olumbia University Scho Poghosyan).

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Protection and Affordable Care Act, 2010). Projected increases in demand for care have led policy makers to call for an expansion of the primary care workforce (Institute of Medicine, 2010; National Governors Association, 2012). Currently, physicians, nurse prac- titioners (NPs), and physician assistants provide the bulk of primary care in the United States (Agency for Healthcare Research and Quality, 2012). One set of projections estimates that by 2025, an additional 52,000 physicians will be needed to meet the severe demand for primary care services (Petterson et al., 2012). This estimate is alarming given that the primary care

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