Kim, Do Kyung
(2024)
The impact of primary care nurse practitioner autonomy on workforce outcomes across various team compositions.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Background: Nurse practitioners (NPs) are expected to take a central role in the future delivery of primary care working as autonomous providers within multidisciplinary teams. However, given the challenging work environments that often exist in primary care, it is imperative to understand the impact of their autonomy and teamwork on workforce outcomes such as burnout, job satisfaction, and turnover intention. While greater NP autonomy may lead to better workforce outcomes, effective teamwork can further improve these outcomes. However, few studies have examined the impact of NP autonomy and teamwork on NP workforce outcomes.
Purpose: We sought to examine the extent to which NP autonomy, NP teamwork, and their interaction are associated with NP workforce outcomes in primary care practices.
Methods: For our analyses, we used survey data obtained from 1,244 primary care NPs working for 1,109 practices in six states (Arizona, New Jersey, Washington, Pennsylvania, California, and Texas). Firstly, we conducted structural equation modeling (SEM) to estimate the associations between NP autonomy, measured by NP panel management, and NP workforce outcomes, with workload, measured by work hours, serving as a mediating variable. Secondly, we performed latent class analysis (LCA) to identify different primary care team compositions (an important determinant of teamwork) in which NPs work, using a survey item where NPs selected healthcare providers and staff they considered team members. We then assigned NPs to each distinct team composition based on their modal posterior probability and fit probit regression models to compare workforce outcomes among NPs in various team compositions. Lastly, we fit probit regression models to determine whether team composition identified in the previous step moderated the relationship between NP autonomy and workforce outcomes.
Results: 1) In SEM, fully autonomous management led to more burnout than co-managing (B=0.089, bias-corrected 95% bootstrap confidence interval [0.028, 0.151]). Work hours partially (27%) mediated this relationship. There were no significant differences in job satisfaction or turnover intention depending on the degree of autonomy in NP panel management. 2) Based on the LCA model fit evaluation, we selected a five-class solution. Conditional probabilities indicated that NPs in teams with frequent and extensive contact with other providers and staff, along with sufficient ancillary support, reported better workforce outcomes compared to those in teams with minimal contact with other providers and staff and limited ancillary support. However, results from the fully adjusted probit regressions suggested that workforce outcomes did not significantly differ across different team compositions. Further investigation revealed that the NP work environment, as an individual covariate, most effectively mitigated the influence of team composition on NP workforce outcomes. 3) The results of moderation analyses indicated that NPs with greater autonomy in panel management were more likely to experience poorer workforce outcomes, such as increased burnout and turnover intention, when working in teams compared to practicing alone.
Implications: NPs with greater autonomy in panel management tend to experience poorer workforce outcomes, and these outcomes worsen when they work in teams compared to practicing alone. Favorable work environments for NPs in specific team compositions can improve NP workforce outcomes. Specifically, for NPs with greater autonomy in panel management, optimal teamwork and additional support beyond the team may improve NP workforce outcomes and maximize the care provided by these NPs. Future research should incorporate patient characteristics and explore team processes across various primary care team compositions to gain deeper insights into the workforce outcomes for NPs with greater autonomy in primary care.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
28 August 2024 |
| Date Type: |
Publication |
| Defense Date: |
9 July 2024 |
| Approval Date: |
28 August 2024 |
| Submission Date: |
16 August 2024 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
136 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Nurse practitioner
Primary care
Autonomy
Panel management
Team composition
Workforce outcomes |
| Date Deposited: |
28 Aug 2024 13:11 |
| Last Modified: |
28 Aug 2024 13:11 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/46938 |
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