PRACTICE ENVIRONMENT EFFECTS ON NP AUTONOMY AND PATIENT OUTCOMES IN AMBULATORY CARE

Purpose/Aim:The Patient Affordable Care Act (2010) emphasizes the need for the nursing profession, especially Nurse Practitioners (NP), to be the central force in meeting the anticipated increased health care demands and needs of the wave of Baby Boomer retirees. With the profession’s proximity to patients, NPs can yield favorable outcomes in safe and efficient patient care depending on the practice environment characteristics in which NPs work. However, there is sparse research about the relationship between NP practice and patient outcomes as influenced by the practice environment characteristics in ambulatory care.  Therefore, it is vital to examine what practice environment characteristics contribute to the relationship between NP autonomy and patient outcomes in ambulatory care.  The purpose of this abstract is to describe the process of how the phenomenon of interest will be studied, using the Evolutionary Transitions Model (ETM) to harvest findings to illuminate the relationship between NP autonomy and patient outcomes in ambulatory care.

Theory: ETM is based on Donabedian’s (1966) structure, process, and outcomes model. The author conceived the four main constructs (structure, perceived organizational support, transition agent, and transition recipent) of ETM from Eisenberger’s (1986) perceived organizational support and Meleis’s (2000) health transitions theory. EMT provides the framework for studying and categorizing characteristics of organizational structure (practice environment) that may influence the relationship between NP autonomy and patient outcomes in ambulatory care. Structure includes attributes, such as leadership, communication, and staffing within the organization, that affect the quality and quantity of care provided. Organizational support refers to the NP’s perception of specific organizational structural attributes that support the NP’s practice. Transition agent is the NP’s independent and interdependent role. The interdependent role of the NP denotes functions and activities of the NP that partially or entirely depend on another health care provider’s functions or actions to complete their own activities. For instance, the NP will continuously monitor patient condition and consult with the doctor about any changes. In the course of a patient’s care experience, the NP plans and coordinates services to prepare the patient for transition from one episode of care to the next. NP’s independent role refers to role function and responsibilities only NPs can be accountable for.  They include nursing assessment, diagnosis, planning, and evaluation of patient care, which do not require a physician’s order. The patient, a holistic being, is the transition recipient. 

Discussion/Conclusion: EMT is used to explicate how organizational structure characteristics may be mediated by NPs’ perceived organizational support, and affect the relationship between the NP’s practice autonomy and patient outcomes in ambulatory care. The dynamic and complex systemic relationships between the four constructs provide the framework to guide research and examine the relationships between the NP’s practice autonomy and patient outcomes as influenced by organizational structural characteristics in ambulatory care.