title: Nurse Practitioner Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey.
abstract: The Nurse Practitioner (NP) workforce represents a substantial supply of primary care providers able to contribute to meeting a growing demand for care. However, controversy exists regarding the expanding role of NPs in primary care in terms of challenging the teamwork between NPs and physicians. To date, no empirical evidence exists regarding how to promote teamwork in primary care between NPs and physicians.
  
  
  
  We investigated whether NP autonomy within primary care practices and the relationships they have with leadership affect teamwork between NPs and physicians.
  
  
  
  Using a cross-sectional survey design, data was collected from 163 primary care practices in Massachusetts.
  
  
  
  Three hundred and fourteen primary care NPs completed and returned the mail survey yielding a response rate of 40 %.
  
  
  
  The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. These measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the individual NP level using the Teamwork (TW) scale.
  
  
  
  The multilevel linear regression models investigated the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean TW score increased by 0.271 units (p < 0.0001). With every unit increase of NP-AR centered at the grand mean, the mean TW score increased by 0.375 (p < 0.001). Over one-third (41.3 %) of the variance in teamwork could be explained by the final model.
  
  
  
  The study findings demonstrate that NP autonomy and favorable relationships with leadership improve teamwork. Policy and organizational change should focus on promoting NP autonomy and improving the relationship between NPs and leadership to improve teamwork and consequently improve patient care and outcomes.
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY, 10032, USA. lp2475@cumc.columbia.edu.
authors.forename: Lusine
authors.initials: L
authors.lastname: Poghosyan
authors.affiliation: Columbia University School of Nursing, 617 West 168th Street, New York, NY, 10032, USA.
authors.forename: Jianfang
authors.initials: J
authors.lastname: Liu
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003430:Cross-Sectional Studies; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007857:Leadership; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D009722:Nurse Practitioners / Q000458:organization & administration*; D024802:Nurse's Role; D019555:Physician-Nurse Relations; D011320:Primary Health Care / Q000458:organization & administration*; D017009:Professional Autonomy; D011795:Surveys and Questionnaires
keywords: nursing; primary care; workforce