Utilization of Advanced Practice Registered Nurses in Rural Healthcare Settings
Cross-sectional surveys were conducted in two rural states with APRNs to determine autonomous and empowerment characteristics and influencing variables practice setting, geographical location, and physician oversight. The hypothesis is that APRNs, practicing in a rural, clinic setting have less physician oversight and are more empowered and autonomous than other APRNs.
Rationale/Background: Following the ACA’s first open enrollment period, an estimated 9.5 million U.S. adults were newly insured (Commonwealth Fund, 2014). As of June 2014, data indicated there are approximately 6,100 designated Primary Care Health Professional Shortage Areas (HPSAs) nationally. Primary Care HPSAs are based on a physician to population ratio of 1:3,500. Using this formula, it would take approximately 8,200 additional primary care physicians (PCPs) to eliminate the current primary care HPSA designations. We speculate that with this growing shortage of PCPs, APRNs will be required to practice to their fullest capacity (Fairman, Rowe, Hassmiller & Shalala, 2011), to augment the number of care providers. However, barriers exist that could hinder implementation (Brooten, Youngblut, Hannan & Guido-Sanz, 2012).
Methods: Using survey methodology with a descriptive, correlational design, data was collected from APRNs regarding autonomy and empowerment in their professional workplace setting in 2 predominantly rural states. The Dempster Practice Behavior Scale (DPBS) was used to measure autonomy, defined as the ability to function independently (Dempster, 1990). The Conditions of Work Effectiveness Questionnaire-II (CWEQ-II) was used to measure empowerment or power to make decisions (Laschinger, Finegan, Shamian & Wilk, 2001). Descriptive statistics were used for analyzing demographic data. Relationships between autonomy and empowerment, predictor variables and demographics were examined using t-tests and chi-square analysis.
Results: Responding APRNs scored high as autonomous and empowered. Statistically significant were APRNs practicing in a rural setting who had higher autonomy scores than those in an urban setting (p= 0.023) and those who practiced with physician oversight scored higher in empowerment than those who identified no physician oversight (p= 0.001). Physician oversight was positively related to empowerment but inversely related to autonomy. While not significant, other results include APRNs as more empowered in a hospital setting, but scored higher in autonomy when practicing in a clinic. Fifty-two percent (52%) identified practicing with physician oversight.
Implications: Because there is more opportunity to work within a team of healthcare providers in the urban setting, these results may indicate that APRNs are more confident in a situation where members are working in a collaborative effort. Rural APRNs and other healthcare providers have an opportunity to mimic this collaborative effort, requiring all providers to practice at optimum levels of education and experience, understanding of each other’s roles that support these characteristics.