title: Perceived barriers to nurse practitioner practice in rural settings.
abstract: BACKGROUND
  Rural residents experience the same incidence of acute illness as urban populations and have higher levels of chronic illness. Overall, access to adequate rural health care is limited. Nurse practitioners (NPs) have been identified as safe, cost-effective providers in meeting these challenges in rural settings.
  
  
  OBJECTIVE
  This replication study was conducted to examine NP perceptions of barriers to rural practice in Minnesota. Findings were compared to earlier studies to examine issues that have persisted over time.
  
  
  METHODS
  A Barriers to Practice checklist was mailed to NPs from the database of the Board of Nursing of a midwestern state. Rural NPs (n = 191) identified and described barriers to practice and rated the overall restrictiveness of their practice.
  
  
  RESULTS
  Barriers to practice were perceived to be prevalent. Persisting barriers continued to stand in the way of full utilization of NP roles. Lack of understanding of NP roles on the part of the public and other health professionals has been particularly problematic over time. Key issues in 2001 were low salaries, lack of adequate office space, and a limited peer network. Perceived restrictiveness of the practice climate, gauged as somewhat restrictive, remained unchanged between 1996 and 2001.
  
  
  CONCLUSIONS
  NPs have an excellent history of meeting rural primary health care needs. Enhancing the NP work environment could prove instrumental to retaining these professionals in the work force and thereby contribute to improved access and quality of care in underserved rural communities.
authors.affiliation: School of Nursing, University of Minnesota, Minneapolis, Minn. 55455-0342, USA. linde001@tc.umn.edu
authors.forename: Linda
authors.initials: L
authors.lastname: Lindeke
authors.forename: Angela
authors.initials: A
authors.lastname: Jukkala
authors.forename: Mary
authors.initials: M
authors.lastname: Tanner
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009722:Nurse Practitioners / Q000706:statistics & numerical data*; D024802:Nurse's Role; D017009:Professional Autonomy; D011365:Professional Practice Location; D019035:Rural Health Services; D000078329:Workforce