Newswise — New York, NY (September 5, 2017)--Nurse practitioners (NPs) whose healthcare organizations supported their practice as independent clinicians, were more likely than those who worked in less supportive environments to have their own patient panels (groups of patients to whom they delivered ongoing primary care), researchers from Columbia University School of Nursing report.

Results from a quantitative, cross-sectional survey indicate that NPs needed access to organizational resources and supports to be able to deliver ongoing continuous care to their patients, such as physicians’ support of their patient care decisions, staff help in preparing patients for visits, and the freedom to apply their knowledge and skills to patient care.

“These aspects of the NP work environment allowed NPs to serve as primary care providers for their patients,” said lead author Lusine Poghosyan, PhD, and assistant professor of nursing at Columbia University School of Nursing. “The findings suggest that work environments that support NPs’ independent practice may be important factors in meeting the nation’s growing need for primary care.”

To investigate the role that NPs play in healthcare delivery, and to understand how work environments affect this role, Poghosyan and colleagues surveyed 807 NPs who were listed in the Massachusetts Provider Database as delivering of primary care. In addition to NPs’ role in care delivery, the survey measured NP work environment, and demographics.

To measure NPs’ role in care delivery, researchers asked NPs to report whether they had their own patient panel to whom they delivered ongoing continuous primary care. To measure NPs’ work environment, researchers used the Nurse Practitioner Primary Care Organizational Climate Questionnaire (NP- PCOCQ), which asked NPs to rate certain characteristics of their organizations, including their relationships with physicians and administrators, the support they received to practice independently, and their visibility within their healthcare organizations.

The survey also collected information on demographics and work characteristics of NPs, including their age, sex, education, years of work experience, and the location, type, and size of their practice.

A total of 314 NPs from 163 primary care organizations participated in the survey. Most (96 percent) were female. About 45 percent of the respondents, most of whom worked in community health centers, reported having their own panel of patients to whom they provided ongoing primary care.

Notably, support for independent practice was the one dimension of NPs’ work environment that had a significant positive effect on their role in care delivery. According to Poghosyan, “With one unit increase on the organization-level Independence Practice and Support (IPS) subscale score, the incidence of NPs serving as primary care providers with their own patient panel almost doubled.”

The paper entitled “Nurse practitioners as primary care providers with their own patient panels and organizational structures: A cross-sectional study,” was published in the September 2017 issue of International Journal of Nursing Studies. Other study contributors are Jianfang Liu, Assistant Professor of Quantitative Research and Allison A. Norful, Postdoctoral Fellow, also from Columbia University School of Nursing.

This study was supported by the Robert Wood Johnson Foundation, Agency for Healthcare Research and Quality, and the National Institute of Nursing Research (NINR).

The authors declare no financial or other conflicts of interest.



Columbia University School of Nursing is part of the Columbia University Medical Center, which also includes the College of Physicians & Surgeons, the Mailman School of Public Health, and the College of Dental Medicine.  With close to 100 full-time faculty and 600 students, the School of Nursing is dedicated to educating the next generation of nurse leaders in education, research, and clinical care. The School has pioneered advanced practice nursing curricula and continues to define the role of nursing and nursing research through its PhD program which prepares nurse scientists, and its Doctor of Nursing Practice (DNP), the first clinical practice doctorate in the nation. Among the clinical practice areas shaped by the School’s research are the reduction of infectious disease and the use of health care informatics to improve health and health care. For more information, please visit: