title: Practice environment and the employment of nurse practitioners, physician assistants, and certified nurse midwives by community health centers.
abstract: This report examines the relation between state variations in the regulation of nurse practitioners (NPs), physician assistants (PAs), and certified nurse midwives (CNMs), and the employment of these nonphysician providers (NPPs) by community health centers (CHCs). Data for this report came from a 1991-92 survey of CHCs assessing the employment of NPPs, and secondary available data. The dependent variables examined were the numbers of NPPs currently employed by CHCs. Independent variables included 1992 practice environment scores, CHC location, number of CHC physicians, and NPP-to-population ratios. The number of NPs and PAs employed by CHCs was significantly associated with practice environment for these practitioners. NPP-to-population ratios and the number of CHC physicians are also significantly associated with NPP employment by CHCs. State decision makers may reduce legislative and regulatory barriers to practice as a way to improve the practice environment for nonphysician primary care providers, particularly NPs and PAs. Thus, community health centers can employ adequate number of NPPs to fulfill their mission of serving the poor and underserved population.
authors.affiliation: Department of Health Administration, School of Public Health, University of South Carolina, Columbia 29208, USA.
authors.forename: L
authors.initials: L
authors.lastname: Shi
authors.forename: M E
authors.initials: ME
authors.lastname: Samuels
mesh_terms: D002568:Certification; D003151:Community Health Centers; D004651:Employment / Q000706:statistics & numerical data*; D006302:Health Services Research; D006801:Humans; D008004:Licensure / Q000331:legislation & jurisprudence; D009721:Nurse Midwives / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D009722:Nurse Practitioners / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D010823:Physician Assistants / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D017009:Professional Autonomy; D012044:Regression Analysis; D014481:United States; D000078329:Workforce