title: Embattled and embittered or empowered and evolving: nurse practitioner attitudes toward managed care.
abstract: OBJECTIVE
  To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them.
  
  
  METHODS
  NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice.
  
  
  CONCLUSIONS
  The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.
authors.affiliation: School of Nursing, University of Massachusetts, Amherst, Massachusetts, USA. efhayes@nursing.umass.edu
authors.forename: Eileen F
authors.initials: EF
authors.lastname: Hayes
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003362:Cost-Benefit Analysis; D004282:Documentation; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007588:Job Satisfaction; D008329:Managed Care Programs / Q000458:organization & administration*; D008404:Massachusetts; D008875:Middle Aged; D009341:Negativism; D009722:Nurse Practitioners / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D024802:Nurse's Role / Q000523:psychology; D015404:Nursing Methodology Research; D011209:Power, Psychological; D011320:Primary Health Care / Q000458:organization & administration; D017009:Professional Autonomy; D012051:Reimbursement Mechanisms / Q000458:organization & administration; D012944:Social Support; D011795:Surveys and Questionnaires; D017748:Time Management; D016526:Workload / Q000523:psychology