Nurse Practitioner Care Environments and Provider Shortages Among Patients With Multiple Chronic Conditions.
Amy McMenamin, Eleanor Turi, Jianfang Liu and 2 others
PMID 39888032WHAT IT FOUND
Better nurse practitioner work environments lowered hospitalization odds in areas without provider shortages, but not in shortage areas.
Improving practice support alone did not reduce hospitalizations where staffing is critically low.
Key findings
01In areas without primary care provider shortages, better NP care environments were associated with lower odds of hospitalization, whereas in shortage areas, this benefit was not observed.
02The NP care environment did not significantly moderate the relationship between provider shortages and emergency department use.
03In the worst NP care environments, patients in shortage areas had 22% lower odds of hospitalization than those in non-shortage areas, but in the best environments, they had 17% higher odds.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study design was cross-sectional, so it cannot infer causality. The sample was limited to five states and was not nationally representative. The analysis only included practices that employed nurse practitioners, limiting generalizability to other settings. HPSA status was treated as a binary variable (shortage vs. no shortage), so the study could not differentiate between mild, moderate, or severe shortages. NP care environment scores were based on self-report surveys, which may be subject to bias.
Declared interests
The study was supported by the National Institute on Minority Health and Health Disparities (R01 MD011514). No other conflicts of interest were reported.
The easy way to misread this
Do not conclude that improving NP work environments is ineffective in shortage areas. The finding that better environments correlated with higher hospitalization odds in shortage areas may reflect that excellent environments enable more timely detection of serious illness, leading to appropriate hospital referrals rather than missed care.