title: Organizational factors influencing nurse practitioners' role implementation in acute care settings.
abstract: The purpose of this study was to explore the influence of organizational factors on the Acute Care Nurse Practitioner (ACNP) role implementation. A descriptive correlational design, incorporating quantitative and qualitative methods for data collection was used. The sample of convenience consisted of 57 ACNPs assigned to various medical and surgical programs within acute care hospitals. Ten ACNPs participated in the unstructured qualitative interviews. In addition to the interviews, data pertinent to various organizational factors, including role formalization, receptivity of the role by others, perceived autonomy, role strain, and additional factors that may interfere with role implementation, were collected through a self-report structured questionnaire. A four-diary day was completed to gather data on role implementation. Descriptive and correlational statistics were used to analyze the quantitative data. The qualitative data were content analyzed. The ACNPs engaged most frequently in activities reflective of the clinical practice component of the role and less frequently in the non-clinical components (i.e., education, administration, and research). Results of the quantitative and qualitative analyses indicated that lack of formal clear job description, conflicting demands and expectations, lack of receptivity of the role by others, lack of autonomy, and increased workload were negatively correlated with the ACNP role implementation. The ACNP role implementation varies across practice settings. This variability should be accounted for when examining outcomes of ACNP care.
authors.affiliation: Faculty of Nursing, University of Toronto, ON.
authors.forename: D
authors.initials: D
authors.lastname: Irvine
authors.forename: S
authors.initials: S
authors.lastname: Sidani
authors.forename: H
authors.initials: H
authors.lastname: Porter
authors.forename: L
authors.initials: L
authors.lastname: O'Brien-Pallas
authors.forename: B
authors.initials: B
authors.lastname: Simpson
authors.forename: L
authors.initials: L
authors.lastname: McGillis Hall
authors.forename: J
authors.initials: J
authors.lastname: Graydon
authors.forename: A
authors.initials: A
authors.lastname: DiCenso
authors.forename: D
authors.initials: D
authors.lastname: Redelmeir
authors.forename: L
authors.initials: L
authors.lastname: Nagel
mesh_terms: D000208:Acute Disease / Q000451:nursing*; D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration*; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009722:Nurse Practitioners / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role / Q000523:psychology; D015401:Nursing Administration Research; D015404:Nursing Methodology Research; D009864:Ontario; D015279:Organizational Culture; D016134:Organizational Policy; D011209:Power, Psychological; D017009:Professional Autonomy; D011446:Prospective Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D013996:Time and Motion Studies; D016526:Workload