title: The impact of ethics and work-related factors on nurse practitioners' and physician assistants' views on quality of primary healthcare in the United States.
abstract: OBJECTIVE
  Nurse practitioners (NPs) and physician assistants (PAs) provide primary care services for many American patients. Ethical knowledge is foundational to resolving challenging practice issues, yet little is known about the importance of ethics and work-related factors in the delivery of quality care. The aim of this study was to quantitatively assess whether the quality of the care that practitioners deliver is influenced by ethics and work-related factors.
  
  
  METHODS
  This paper is a secondary data analysis of a cross-sectional self-administered mailed survey of 1,371 primary care NPs and PAs randomly selected from primary care and primary care subspecialties in the United States.
  
  
  RESULTS
  Ethics preparedness and confidence were significantly associated with perceived quality of care (p<0.01) as were work-related characteristics such as percentage of patients with Medicare and Medicaid, patient demands, physician collegiality, and practice autonomy (p<0.01). Forty-four percent of the variance in quality of care was explained by these factors.
  
  
  CONCLUSIONS
  Investing in ethics education and addressing restrictive practice environments may improve collaborative practice, teamwork, and quality of care.
authors.affiliation: University of Pennsylvania School of Nursing, Department of Medical Ethics and Health Policy, and New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, PA 19104, USA. Electronic address: culrich@nursing.upenn.edu.
authors.forename: Connie M
authors.initials: CM
authors.lastname: Ulrich
authors.affiliation: George Washington University, Ashburn, Virginia, VA 20147, USA.
authors.forename: Qiuping Pearl
authors.initials: QP
authors.lastname: Zhou
authors.affiliation: University of Pennsylvania School of Nursing, Philadelphia, PA 19104, USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Hanlon
authors.affiliation: Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: Marion
authors.initials: M
authors.lastname: Danis
authors.affiliation: Department of Bioethics, National Institutes of Health, Bethesda, MD 20892, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Grady
mesh_terms: D000328:Adult; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000523:psychology*; D010823:Physician Assistants / Q000523:psychology*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D014481:United States
keywords: Ethics confidence; Ethics preparedness; Nurse practitioners; Physician assistants; Practice autonomy; Quality of care