Longudlflal ’ flue o ‘ ~v CH"— PHASE II U.S, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBHC HEALTH SERVICE I MALI“ RESOURCES ADMINISTRATION gum Ila/,3 a flag; 4 OflgItUdIfla W ftUO g WU C I DQACW OH PHASE II Wll 6 SEPTEMBER 1978 Health Manpower References“ / . {HE A DHEW Publicationyo. 78-92 U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE PUBLIC HEALTH SERVICE I HEALJ’H SOURCES ADMINISTRATION- BUREAU OF HEALTH MANPOWE I DIVISION OF NURSING HYATTSVILLE, M RYLAND 20782 4.. ,‘j” ,4 ' "I v (- V \. ,, ,,, "" ' ,3”, , x v. 5'5 #555” 3‘51, t a a 02. M/ ML » K» '9, ,:,!,5‘-'»,,Vu,ll'l 3M {3' ‘7'.“ m 2' lap Will" :' M: A , ‘3" ' I‘Q’fla’ 1 CW uu'aJWK‘EW 5‘; Wm. ,3: .f, “at Ma... ' 31M» ‘2. ‘v a. 1W» WWW? it 3.33333 "31,54 Wm?“ . till «3» W DISCRIMINATION PROHIBITED—Title VI of the Civil Rights Act of 1964 states: “No person in the United States shall, on the ground of race, color, or national origin, be excluded from partici- pation in, be denied the benefits of, or be subjected to discrimina- tion under any program or activity receiving Federal financial assistance.” Therefore, the nursing distribution analysis program, like every program or activity receiving financial assistance from the Department of Health, Education, and Welfare, must be operated in compliance with this law. The research reported in this publication was performed under Public Health Service Contract Number N01 NU 34064 from the Division of Nursing, Bureau of Health Manpower, Health Resources Administra- tion. Division of Nursing project officers are 0. Marie Henry, R.N., D.N.Sc., Chief, Nursing Practice Branch, and Harriet D. Carroll, R.N., M.N., Consulting Nurse, Nursing Research Branch. The authors of this report are: Harry A. Sultz, D.D.S., M.P.H., Professor Maria Zie ezny, Ph.D., Assistant Professor Jane Mathews Gentry, M.P.H., Clinical Assistant Professor Department of Social and Preventive Medicine School of Medicine State University of New York at Buffalo and Louis Kinyon, B.A. Project Supervisor For sale by the Superintendent of Documents, US. Government Printing Office Washington, DC. 20402 Stock Number 017—041—00128—9 II FOREWORD The Division of Nursing has long supported the preparation of nurses for expanded roles. The educational preparation of nurse practitioners and their subsequent utilization in the provision of health care has been a growing trend since the mid-1960’s. With the present emphasis on primary health care needs and focus on preventive health services, there is every indication that the need for nurse practitioners will continue. The study reported in this publication constitutes the first major effort to collect nationwide data on nurse practitioner education and practice. This study was an outgrowth of the Division’s recognition of a lack of reliable national data on which to base evaluation of its past efforts in nurse practioner education and to plan effectively for the future. Phase I findings of this study, which described the programs and students in them, were published in 1976 (DHEW Publication No. HRA 76—43). This current report presents findings from Phase II of this longitudinal study. The cohort of students identified in Phase I was followed after graduation to determine the type and success of their subsequent employment, their impact on the health care delivered in various settings, and the relationship between their functions in the employment setting and the ones for which they were educationally prepared. The data obtained in this study are of demonstrated value, not only to the Division of Nursing for future planning, but to educators and health planners who must make decisions critical to future preparatory and service programs. 2"" JESSIE M. SCOTT Assistant Surgeon General Director Division of Nursing III ACKNOWLEDGMENTS In the report of Phase 1, we described in detail the history of the project and acknowledged the many persons who contributed so gen- erously to its design and implementation. Although we do not want to list again all of those whose expertise, encouragement, and support contrib- uted so much to the study, we do want to acknowledge those key individuals who made this document possible. The coproject officers, Dr. Marie Henry and Mrs. Harriet Carroll, have continued to provide expert and essential guidance throughout the con— duct of the project and the preparation of its publications. We are deeply indebted for their most helpful direction. Dr. Judy Sullivan from the School of Nursing, University of Rochester, has served actively as our consultant and has contributed greatly to the analytic and interpretive aspects of this document. We wish to express a special word of appreciation to Jessie M. Scott, Assistant Surgeon General and Director of the Division of Nursing, whose continued support and encouragement have contributed so much to the success of this endeavor. The authors are deeply indebted to Frances Sherwin, Frank Rens, Donald McGreevy, Joan Craft, and other members of the Department of Social and Preventive Medicine, whose special skills and continuous efforts were required to complete the study and prepare this manuscript. HARRY A. SULTz MARIA ZIELEZNY JANE MATHEWS GENTRY LOUIS KINYON IV CONTENTS Foreword Acknowledgments List of Tables and Figures INTRODUCTION METHOD Phase 1 Educational Programs Nurse Practitioner Students Survey Response Phase 2 Nurse Practitioner Graduates Survey Response Explanatory Notes STUDY FINDINGS Employment Characteristics of Nurse Practitioner Graduates Regional Location Status History Income Aspects of Nurse Practitioner Practice Employment Setting Nurse Practitioner Function Nurse Practitioner Motivation; Consequences ____________________ Employer Motivation Acceptance of Nurse Practitioners; Barriers ______________________ Nurse Practitioner and Employer Satisfaction ___________________ SUMMARY TABLES 1—117 APPENDIX A. Nurse Practitioner Questionnaire ____________________ APPENDIX B. Employer Questionnaire ________________________________ V Page III IV VI 010101 0040‘: 11 11 11 14 15 19 21 25 25 26 27 29 31 151 173 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. Tables NP programs, phase 1 student respondents, and phase 2 respondents, by specialty and type of NP program Selected demographic characteristics of phase 2 respond- ents and nonrespondents Selected professional characteristics of phase 2 respond- ents and nonrespondents Responding employers, by specialty and type of NP pro- gram Regional location of graduates, by type of NP program Regional location of graduates, by specialty and type of NP program Employment status of graduates, by type of NP pro— gram Employment status of NP graduates, by specialty and type of NP program Graduates employed full time and part time, by specialty and type of NP program Average number of hours per week employed graduates functioned as NPs and not as NPs, by employment status and type of NP program Employed graduates, by role and type of NP program Selected demographic, characteristics of graduates, by employment status Proportion of graduates who moved from the region of their NP program, by employment status, region of their NP program, and type of NP program Proportion of graduates who moved from the State in which their NP program was located, by employment status, region of their NP program, and type of NP program Selected professional characteristics of graduates, by em- ployment status Employment status of graduates, by number of years in professional nursing and type of NP program Employment status of graduates, by prior nursing prepa- ration and type of NP program Employment status of graduates, by class size and type of NP program Employment status of graduates, by response of their program directors to the question: “Does demand for graduates exceed supply?” and type of NP program V1 Page 31 32 33 34 35 35 36 37 38 39 39 40 41 42 43 44 45 46 47 Tables—continued Page 20. Employment status of graduates, by length and type of NP program 48 21. Employment status of graduates, by length of didactic component and type of NP program 49 22. Employment status of graduates, by whether or not the NP program required a preceptorship and type of NP program 50 23. Employed graduates, by length of employment after graduation to the date of the survey and type of NP program 51 24. Graduates, by employment changes after graduation and type of NP program 51 25. Graduates who reported employment changes, by reasons, employment status, and type of NP program 52 26. Employed graduates, by intervening months between graduation and initial employment and type of NP pro- gram 53 27. Employed graduates, by whether the current employment setting was the same as that prior to NP preparation and type of NP program 53 28. Employed graduates, by intervening months between graduation and first employment, whether the current employment setting was the same as that before NP preparation, and type of NP program 54 29. Graduates who were not employed, by reasons and type of NP program 55 30. Employed graduates not functioning as NPs, by selected employment settings and type of NP program 55 31. Average, gross, annual, nursing income of graduates em— ployed full time and part time, by specialty and type of NP program 56 32. Graduates employed full time and part time, by gross, annual, nursing income and type of NP program 57 33. Graduates employed full time, by gross, annual, nursing income, specialty, and type of NP program 58 34. Average, gross, annual, nursing income of graduates em- ployed full time, by employment status, specialty, and type of NP program 59 35. Average, gross, annual, nursing income of graduates em- ployed full time and part time, by region and type of NP program 60 36. Graduates employed full time, by gross, annual, nursing income, region, and type of NP program 61 VII Tables—continued 37. 38. 39. 40. 41. 42. 43. 45. 46. 47. 49. 50. 51. Average, gross, annual, nursing income of graduates working as NPs, by employment status, practice setting location, and type of NP program Average, gross, annual, nursing income of graduates em- ployed full time before and after NP preparation, by type of NP program Graduates employed full time, by gross, annual, nursing income before and after NP preparation and type of NP program Graduates employed full time, by gross, annual, nursing income before NP preparation, gross, annual, nursing income after NP preparation, and type of NP program Average, anticipated and actual increase in income and average, gross, annual, nursing income after NP prepara- tion of graduates employed full time, by specialty and type of NP program Average, anticipated, and actual increase in income and average, gross, annual, nursing income after NP prepara— tion of graduates employed full time, by employment status and type of NP program Average, anticipated, and actual increase in income and average, gross, annual, nursing income after NP prepara- tion of graduates employed full time, by prior nursing preparation and type of NP program NPs, by the one employment setting in which they spent most of their time as NPs and type of NP program Average number of hours per week NPs functioned as NPs in specific employment settings, by type of NP pro- gram Practice setting location of NPs, by type of NP program Practice setting location of NPs, by specialty and type of NP program Practice setting location of NPs, by region and type of NP program Practice setting location of NPs, by employment setting in which NPs spent most of their time functioning as NPs and type of NP program Average percent of patients in selected income categories served by the practice, by specialty and type of NP program NPs, by Whether they were the first to work in a specific practice setting, specialty, and type of NP program VIII Page 62 63 65 66 67 68 69 7O 71 73 74 76 77 Tables—continued 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 65. 67. NPs, by number of years the practice provided patient care, specialty, and type of NP program NPs, by whether or not NP position was planned when the practice was established, specialty, and type of NP pro- gram NPs, by whether or not NP position was planned when the practice was established, number of years the practice has provided patient care, and type of NP program NPs’ titles in employment settings, by type of NP pro- gram. NPs’v titles in employment settings, by titles most com- monly used by the program to designate graduates and type 6f NP program Percent of NPs engaged in the NP role only and in a combination NP and traditional nursing role, by specific functions and type of NP program Average hours per week NPs were engaged in the NP role only and in a combination NP and traditional nursing role, by specific functions and type of NP program Selected combinations of NP functions, by type of NP program NPs providing and not providing primary care in their current positions, by whether they provided direct patient care in their positions before NP preparation and type of NP program NPs engaged full time and part time in NP functions, by specialty and type of NP program NPs, by percent of total employed time they spent in NP functions and type of NP program NPs, by percent of total employed time they spent in NP functions, employment setting in which they spent most of their time in NP functions, and type of NP program NPs providing selected health care services, by specialty and type of NP program NPs providing selected health care services, by employ— ment setting in which they spent most of their time in NP functions Percent of NPs providing infant and child health care who performed selected functions, by patient classification and type of NP program Average percent of physician consultation NPs providing infant and child health care utilized when performing IX Page 78 79 80 80 81 83 84 85 86 87 89 90 91 92 Tables—continued Page selected functions, by patient classification and type of NP program 93 68. Percent of N Ps providing maternity care/family planning who performed selected functions, by patient classifica- tion and type of NP program 94 69. Average percent of physician consultation NPs providing maternity care/family planning utilized when performing selected functions, by patient classification and type of NP program 95 70. Percent of NPs providing adult health care who performed selected functions, by patient classification and type of NP program 96 71. Average percent of physician consultation NPs providing adult health care utilized when performing selected func- tions, by patient classification and type of NP program 97 72. N Ps prepared to provide specific health care services and the percent providing those services, by specialty and type of NP program 98 73. NPs providing specific health care services and the per- cent prepared to provide those services, by specialty and type of NP program 99 74. Percent of pediatric NPs providing selected types of care to specific categories of patients, by type of NP program 100 75. Pediatric NPs providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program 101 76. Percent of nurse midwives providing selected types of care to specific categories of patients, by type of NP program 102 77. Nurse midwives providing selected types of care to spe- cific categories of patients and the proportion of these midwives employed in practices providing such care, by type of NP program 103 78. Percent of maternity NPs providing selected type of care to specific categories of patients, by type of NP program 104 79. Maternity NPs providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program 105 80. Percent of family NPs providing selected types of care to specific categories of patients, by type of NP program 106 Tables—continued 81. 82. 85. 86. 87. 89. 91. 92. 93. 95. Family NPs providing selected types of care to specific categories of patients and proportion of these NPs em- ployed in practices providing such care, by type of NP program Percent of adult NPs providing selected types of care to specific categories of patients, by type of NP program Adult NPs providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program NPs, by the average number of patients they saw per day in the employment setting in which they spent most of their time functioning as NPs, specialty, and type of NP program NPs, by discipline of persons in the practice who usually saw new patients and patients on followup visits, by type of NP program NPs reporting physician’s availability to discuss patient problems as they occurred, by type of NP program NPs, by the frequency that a physician was physically present during the time that they were functioning as NPs, employment setting in which they spent most of their time as NPs, and type of NP program NPs, by frequency with which a physician or nurse pre— ceptor reviewed their records and type of NP program NPs’ opinions as to ideal length and the actual length of each curricular component of NP preparation, by specialty and type of NP program NPs, by reason(s) for choosing present position and type of NP program NPs, by most important reason for choosing present posi- tion and type of NP program Employer or supervisor respondents, by discipline and type of NP program Employers, by reason(s) for employing the NP and type of NP program Employers, by most important reason for employing the NP and type of NP program Employers, by impressions of the effect(s) of employing the NP and type of NP program Employers, by impressions of the most significant effect of employing the NP and type of NP program XI Page 107 108 109 110 112 113 114 116 117 118 119 119 120 121 122 123 Tables—continued 97. 98. 99. 100. 101. 102. 103. 104. 105. 106. 107. 108. 109. 110. 111. 112. 113. 114. Comparison of employers’ most important reason for em- ploying the NP with their impressions of its most signifi— cant effect, by type of NP program Employers’ most important reason for employing the NP, by their impressions of the most significant effect and type of NP program Employers, by impressions of changes which occurred in conjunction with the employment of the NP and type of NP program Employers, by whether they felt the benefits derived from the NP outweighed the costs and type of NP program Employers, by reasons they felt benefits derived from the NP did not outweigh costs and type of NP program Employers, by impressions of how well various groups accepted the NP role and type of NP program NPs, by impressions of how well various groups accepted the NP role and type of NP program Agreement between NPs and employers in rating the NP role as acceptable to various groups, by type of NP pro- gram Employers, by impressions of barriers to the NP’s role development and type of NP program N PS, by impressions of barriers to their role development and type of NP program Employers reporting selected barriers to the NP’s role development and NP agreement with this impression, by type of NP program NPs, by their degree of general satisfaction with their present positions and type of NP program NPs, by their degree of satisfaction with specific aspects of their present positions and type of NP program NPs employed full time, by their degree of general satis- faction with their present positions, by gross, annual, nursing income, and type of NP program Employers, by their degree of general satisfaction with the NP and type of NP program Employers, by their degree of satisfaction with the NP’s functioning and type of NP program Employers, by their degree of general satisfaction with the NP, the NP’s prior nursing preparation, and type of NP program Employers, by their degree of general satisfaction with the NP and length and type of NP program XII Page 124 125 126 127 127 128 129 130 131 132 133 134 135 138 140 141 143 144 Tables—continued Page 115. Employers’ degree of general satisfaction, by NPs’ degree of general satisfaction and type of NP program 145 116. Average job satisfaction of NPs as exemplified by attain- ment, aspiration, and importance with respect to specific! job characteristics, by type of NP program 146 117. Average job satisfaction of NPs as exemplified by attain- ment, aspiration, and importance with respect to overall job characteristics, by prior nursing preparation and type of NP program 147 Figures Page 1. Regions of United States as designated by the National League for Nursing and percentage distribution of the popu- lation (1970 census) 8 2. Graduates employed full time, by percentage distribution of actual change in income and type of NP program 17 3. Average job satisfaction of NPs as exemplified by attainment in prior nursing position, expectation as an NP, and attainment in the present position, by type of NP program 28 XIII INTRODUCTION The purpose of this longitudinal study of nurse practitioners, initiated in 1973, was to provide national data for the Division of Nursing, Department of Health, Education, and Welfare, which would permit evaluation of the formal educational programs preparing nurses in ex- panded specialty roles. Programs preparing nurse practitioners (NPs) were characterized by considerable variation in duration, content, fac- ulty, and educational philosophy. Therefore, it was particularly impor- tant to relate differences in the employment success, functions, roles, income, and other circumstances of employment to the characteristics of the educational programs from which the nurse practitioners graduated. Among the many unanswered questions which the Division of Nursing felt were basic to future funding decisions were these: First, was nurse practitioner education adequately preparing grad- uates to function in the health care settings in which they were subsequently employed? Second, were the nurse practitioners doing what their educational programs had prepared them to do? The answers to these questions, as well as to a host of others basic to future funding decisions, required that baseline data be obtained which described the national educational effort to prepare nurse practitioners and, then, that a followup study of a cohort of graduates previously enrolled in these educational programs be undertaken. The linking of critical information on education and on employment experience of nurse practitioners after graduation would provide answers to these questions. The term nurse practitioner (NP) as used in this study describes the nurse whose education extends beyond the basic requirements for licen- sure as a registered nurse. Nurse practitioner education is formally planned to prepare students for expanded functions in diagnostic and treatment needs of patients. Educational programs were accepted into this study only after review of their activities indicated that they met the following criteria: 0 They must offer a formal curriculum as opposed to inservice training for their own employees. - They must have started instruction with enrolled students by J an- uary 1, 1974. 2 STUDY PHASE II 0 They must provide preparation in extended nursing roles, i.e., primary care skills, such as history taking, physical examination, ordering laboratory tests, and assuming responsibility for medical management of selected cases with emphasis on primary care. - They must require that students be registered nurses in order to enroll. The information obtained about both programs and students was intended to clarify the numbers and types of nurse practitioner educa- tional programs, the entrance requirements, curricula lengths and con— tents, and the faculty participation in that preparation. Of particular importance were questions relating to the responsibilities and roles for which nurses were being prepared and their expectations regarding future employment, income, and function. These data were published by the Department of Health, Education, and Welfare in March 1976. The monograph is entitled Longitudinal Study of Nurse Practitioners: Phase I and may be obtained from the Government Printing Office by request- ing DHEW publication number (HRA) 76—43, stock number 017—041— 00111—4. This report combines the information obtained in phase 1 With the followup information obtained from nurse practitioners and their em- ployers for phase 2. The phase 2 findings delineate nurse practitioner functions in practice settings and explore the relationships between those functions and the ones for which nurse practitioners were educationally prepared. The reader is cautioned to remember that the findings for this report combine information obtained from hundreds of individual NPs practicing in villages, towns, and cities throughout the United States. This presentation represents an attempt to draw a national profile of the nurse practitioner movement and because the profile has been based on the compilation of voluminous data, the focus is not on individual varia- tions. Just as the fine detail becomes obscured in a painting executed in broad strokes, so too, exceptions to these aggregated findings that are not described in this report may be identified. The overriding importance of the data is not the specific descriptions of the myriad of situations in which nurse practitioners find themselves, but rather the direction provided to educators, policymakers, and health care planners in clarify- ing the developing trends in the acceptance and employment of nurse practitioners. As in any document containing a great deal of factual information based on a magnitude of data, alternate interpretations are possible and even probable. Persons with different points of view may find evidence to support their theses. For this reason, the interpretive text has purpose- fully been limited to pointing out the more significant findings with a minimum of subjective comment. Other forums will permit the discussion METHOD 3 of these data at greater length. If this publication serves to answer only some of the many questions raised about the nurse practitioner move- ment and provides help to those who must provide the direction for advancing the health care capability of this Nation, then the very large effort required to produce this publication will have been worthwhile. METHOD Phase 1 Educational Programs—The first task of phase 1 was to identify those programs offering education of nurses in expanded roles which met the predetermined criteria from lists prepared by the Division of Man- power Iritelligence, Health Resources Administration, and by the American Nurses’ Association. Approximately 100 institutions sponsor- ing over 100 certificate and 180 master’s degree programs were queried by telephone to determine if they met the criteria. Program directors were asked to indicate whether their programs prepared students pri- marily for. care in ambulatory care settings rather than institutional inpatient care settings and whether the program emphasized preparation in the primary care skills of history taking, physical examinations, ordering of laboratory tests, and assuming the medical management of uncomplicated cases. An affirmative response regarding these two cri- teria qualified the program to receive a mailed self-administered ques- tionnaire designed to elicit information on program history, entrance requirements, student selection, curriculum, faculty, and funding. The returned questionnaires were carefully reviewed to verify the appropri— ateness of each program’s inclusion in the study. These two screening procedures produced a revised listing of programs eligible for inclusion in the study. The study universe was thereby reduced to 87 programs which awarded a certificate and 46 programs which awarded a master’s degree. The data do not include programs initiated after January 1, 1974. NP students—In a cover letter that accompanied the program ques— tionnaire, program directors were requested to distribute a question- naire to each student in the current class who would graduate between May 1974 and June 1975. Data on prior background and training, pre- vious work experience and income, previous functions in the nursing role, the degree of satisfaction in previous roles, the stimuli to enter nurse practitioner programs, and expectations of the program and subsequent employment were obtained. The students who completed and returned the initial questionnaire constituted the cohort of nurse practitioners who were to be followed in phase 2 of the study. Survey response—The response rate for educational programs was nearly perfect. Only one certificate and one master’s program did not participate, resulting in an overall response rate of 99 percent for certificate programs and 98 percent for master’s programs. The response for students was 85 percent for certificate programs and 84 percent for 5 6 STUDY PHASE II master’s programs. A total of 794 certificate students and 307 master’s students responded to the first phase. Although response rates for students varied by specialty and by type of program, participation was more than adequate for this longitudinal study. Phase 2 NP graduates—Phase 2 consisted of a followup of the nurse practi- tioner cohort and a survey of the employers of those nurse practitioners providing primary care by means of self-administered questionnaires approximately 1 year after graduation. The two questionnaires were pretested on a small sample of 32 subjects and corresponding employers selected to represent each of the specialities, both certificate and mas- ter’s degree programs and urban and rural employment locations. The nurse practitioners participating in the pretest were in the class previous to that of the nurse practitioner cohort. Both questionnaires were revised slightly following the pretest. A questionnaire to be completed by the nurse practitioner and one to be given to the employer were then mailed to each of the 1,099 former nurse practitioner students a minimum of 6 months following the ex- pected completion of the nurse practitioner program. Two nurse practi- tioner students from phase 1 did not identify themselves and therefore could not be queried for phase 2. Copies of the two questionnaires are included with this report as appendixes A and B. The data gathered for phase 2 were concerned with the geographic location of nurse practitioner graduates, their employment status, their employment history, and the income they received from nursing. Data about those graduates actually working as nurse practitioners were obtained in terms of changes of employment, the nature and size of the setting in which they were employed, the time spent with patients and the characteristics of the patients seen in the practice setting, the location of the practice setting, the income of patients seen in the practice setting, the history of the practice and the history of the nurse practi- tioner’s role in the practice, how nurse practitioners functioned, the kinds of care they provided, the patients they cared for, personnel in the practice setting with whom they interacted, supervision of the nurse practitioners, salaries of nurse practitioners and the factors which may have affected the amount of their salaries, reasons employers chose a nurse practitioner and the reasons nurse practitioners chose their current employment, acceptance of the nurse practitioner role in the employment setting, outcomes of nurse practitioner employment, and the nurse practitioners’ opinions as to ideal length of the various components of their preparation. Analyses of these data involved cross tabulations of appropriate vari- METHOD 7 ables from both phase 1 and phase 2 so that subsequent employment could be related to student and program characteristics. Survey response.—Tables 1—4 present the response to phase 2 of the survey. An overall response rate of 68.5 percent was attained in phase 2 from the student cohort which had responded to phase 1. An overall response rate of 83 percent was obtained from the employers of nurse practitioners providing primary care. With few exceptions, the demo- graphic and professional characteristics of both respondents and nonre- spondents were similar. In table 2, it can be seen that blacks were slightly underrepresented among respondents. It should be noted that respondents from the West were slightly overrepresented and respond- ents from the Northeast slightly underrepresented. Similarly, in table 3 it can be seen that respondents With baccalaureate or master’s degrees were overrepresented. Of critical importance in judging the potential bias resulting from nonresponse was the question of whether the findings would be affected by high rates of unemployment among nonrespond- ents. An extensive, special effort was made, therefore, to determine the employment status of each nonresponding nurse practitioner graduate. Letters of inquiry and an accompanying questionnaire were sent to program directors to determine the current employment status of nonresponding nurse practitioners. These measures resulted in informa— tion indicating that the rate of successful employment as a nurse practi- tioner was actually higher for nonrespondents than for respondents—88 percent as compared to 70 percent. It is reasonable to conclude that the response to phase 2 of this study was adequate to make generalizations based on the data. 8 STUDY PHASE II Explanatory Notes Many of the same terms used in phase 1 were again used in phase 2. As in the phase 1 findings, the term type of program indicates whether the program awards a certificate or a master’s degree upon completion. Specialty designates six areas of preparation: pediatric, midwifery, maternity, family, adult, and psychiatric. It should be noted that all percentage distributions have been rounded to achieve 100 percent. The symbol in the tables indicates zero value (none) and -- indicates not applicable. The four regions of the United States as designated by the National League for Nursing and the States in each region are illustrated in figure 1. Figure 1.—Regions of the United States as designated by the National League for Nursing and percentage distribution of the population (1970 census) ALASKA HAWAII Connecticut Delaware District of Columbia Maine Illinois Indiana Iowa Kansas Alabama Arkansas Florida Georgia Kentucky Alaska Arizona California Colorado Hawaii Northeast Massachusetts New Hampshire New Jersey New York Midwest Michigan Minnesota Missouri Nebraska South Louisiana Maryland Mississippi North Carolina Oklahoma West Idaho Montana Nevada New Mexico Pennsylvania Rhode Island Vermont , North Dakota Ohio South Dakota Wisconsin South Carolina Tennessee Texas Virginia West Virginia Oregon Utah Washington Wyoming STUDY FINDINGS Employment Characteristics of NP Graduates Of primary interest to those concerned with the education and place- ment of nurse practitioners is a national assessment of the work experi- ences of nurse practitioner program graduates. Therefore, the data deal with the various aspects of the first year’s experience of the more than 700 graduates in the study cohort. It should be noted that this portion of the report deals with all respondents who actually completed nurse practitioner programs: those who, after graduation, were employed either as nurse practitioners, or in nonpractitioner nursing roles, and those who were not employed. Regional location—Tables 5 and 6 and figure 1 present data on the location (by geographic region) of the graduates at the time they com- pleted the questionnaires in phase 2. Table 5 reveals that a relatively high proportion of graduates of nurse practitioner programs in relation to population size were located in the West and that a relatively low proportion were located in the Midwest. Table 6 shows the geographic distribution for each specialty. Pediatric specialists were fairly evenly divided among the four regions and consti- tuted the largest group of nurse practitioners in each area. The other specialties evidenced greater geographic variations. Over half of the graduates of certificate-awarding midwifery programs as compared to fewer than 20 percent of the graduates of master’s—awarding midwifery programs were located in the South. Graduates of both certificate and master’s-level maternity programs were more common in the South than in the other regions. The smallest number of graduates of master’s programs were found in the Midwest. However, the largest proportion of family nurse practitioners graduated from certificate programs located in the West. Almost half of the graduates of adult certificate programs as compared to only 12 percent of the graduates of adult master’s programs were located in the Northeast. It is clear that there are differences in the geographic location of nurse practitioners not only by specialty but also by type of program within specialty. As might be expected, the number of nurse practitioner graduates in a geographic region was directly related to the number of programs offered in that region. The average number of graduates per State and per program varied from two to nine. States with more programs had the higher average number of graduates. Status—Tables 7 to 22 present data on the employment status of nurse practitioner graduates. Overall, 90 percent of the graduates were 11 12 STUDY PHASE II employed, 69 percent as nurse practitioners providing primary care (table 7). Graduates of certificate programs were more likely than grad- uates of master’s programs to be employed as nurse practitioners. Furthermore, graduates of certificate programs were more frequently involved in the provision of primary care. On the other hand, almost 10 percent of graduates of master’s programs compared to only 2 percent of the graduates of certificate programs were involved in activities such as teaching and consulting. Approximately one-third of the graduates of master’s programs compared to fewer than 10 percent of graduates of certificate programs were employed in nonpractitioner nursing roles. A large number were employed as faculty in schools of nursing but, significantly, were not teaching in nurse practitioner programs. A slightly larger percentage of graduates of certificate programs than graduates of master’s programs were not employed. Table 8 presents the employment status of nurse practitioner gradu- ates by specialty. Overall, fewer than 10 percent of the nurse practi- tioners were not employed, but the variation by specialty ranged from 12.5 percent unemployed among pediatric graduates to 5.6 percent among adult graduates. The provision of primary care ranged from a high of almost 80 percent of the graduates of family programs to a low of only 53.6 percent of the graduates of maternity programs (excluding gradu- ates of psychiatric programs). Almost two-thirds of the graduates of maternity programs awarding a master’s degree and almost one-quarter of the graduates of maternity programs awarding a certificate were employed, but not as nurse practitioners. Similarly, more than half of the graduates of adult programs awarding a master’s degree and 40 percent of the graduates of pediatric programs awarding a master’s degree were employed, but not as nurse practitioners. Table 9 illustrates the distribution of employed graduates by whether they were full or part time and by specialty. Almost 86 percent of all employed graduates worked full time, that is, more than 35 hours per week. There was little variation by specialty and type of nurse practi- tioner program. Graduates of master’s programs, when employed, were somewhat more likely than graduates of certificate programs to be employed full time. It should be noted that graduates of nurse practitioner programs often divided their time between nurse practitioner and other activities which could not be considered within the nurse practitioner role. Table 10 illustrates how their work was divided. Graduates of both certificate and master’s programs who were providing primary care spent an average of approximately 7 of their 40 hours per week in nonpractitioner activities. Graduates employed as nurse practitioners for teaching, consulting, or other purposes who were not providing primary care spent approxi- mately one-third of their time on other than nurse practitioner activities. STUDY FINDINGS 13 Table 11 illustrates the fractionalization of employment activities. Overall, almost 50 percent of the employed graduates worked as nurse practitioners only, and an additional one-third worked in various combi- nations of the nurse practitioner and nonpractitioner nursing roles. More than one-half of the graduates of certificate programs compared to a little more than one-third of the graduates of master’s programs functioned in the nurse practitioner role only. Another one-third combined the nurse practitioner role with nonpractitioner nursing activities. Only 11 percent of the graduates of certificate programs reported that they performed only nonpractitioner nursing functions. In contrast, 38 percent of the graduates of master’s programs were employed in only the nonpracti- tioner role. Table 12 presents selected demographic characteristics of the gradu- ates by whether or not they were employed. Married and/or younger graduates were only slightly less likely than others not to be employed. Of primary interest in this table is the lack of significant variation in achieving employment by factors such as geographic region, race, marital status, or sex, which are usually assumed to be important. Those gradu- ates who were not employed were very likely not seeking employment or were not employed for primarily personal reasons (see table 29). Tables 13 and 14 present data on the movement of graduates from the region and State in which the nurse practitioner program was located. Overall, 14 percent of the graduates of certificate programs moved from the regions in which their nurse practitioner programs were located. Graduates of master’s degree programs were twice as likely as graduates of certificate programs to have moved. Mobility of the graduates differed very little by region. These data reveal that graduates employed as nurse practitioners were less inclined than graduates not employed as nurse practitioners to move from the area. Graduates who were not employed were the most mobile. Whether this was cause or effect is, of course, not known. Twenty-eight percent of the graduates of certificate programs and 46 percent of the graduates of master’s degree programs left the State in which their nurse practitioner programs were located (table 14). Table 15, which presents data on selected professional characteristics by whether or not graduates were employed, reveals that those with fewer years of professional nursing and those who changed jobs after graduation were more likely not to have been employed than those with more experience and those who had not changed jobs. Table 16 illustrates the relationship between professional nursing experience and employment status. For graduates of certificate pro- grams, both the likelihood of any kind of employment and specifically the likelihood of employment as a nurse practitioner providing primary care increases with the number of years of prior nursing experience. That relationship is not evident for graduates of master’s programs, however. 14 STUDY PHASE II The largest group of master’s graduates who were either unemployed or who were employed as other than nurse practitioners were among those with 6 to 10 years of professional nursing experience. The type of prior nursing preparation and its relationship to employ- ment as a nurse practitioner has become a topic of considerable interest. Table 17 indicates that the highest level of employment as a nurse practitioner among graduates of certificate programs has been achieved by those nurse practitioners who originally were prepared in hospital diploma programs. Fewer than half of the graduates of master’s pro- grams, most of whom had baccalaureate degrees prior to their nurse practitioner preparation, were employed as nurse practitioners in the provision of primary care; a surprisingly large percent (35.8 percent) were employed in nonpractitioner nursing roles. Table 18, which deals with employment status by class size, reveals that graduates who had attended small classes were less likely to be employed than graduates who had attended larger classes. Unemploy- ment rates were highest for those in classes of fewer than eight students. Table 19 presents a distribution of graduates’ employment status by whether their program directors thought that the demand for graduates exceeded the supply. The program directors were very astute in assess- ing the relationship between demand and supply. Those graduates whose program directors believed that demand exceeded supply were twice as likely to be employed as graduates whose program directors did not think so. Table 20, which is concerned with employment status by program length, shows that graduates of shorter programs were slightly less likely to be employed than graduates of longer programs. Table 21 deals with employment status and length of the didactic component. It shows little or no influence of that variable. Table 22, however, highlights what appears to be the more significant factor, that is, the influence of a required preceptorship. Graduates of certificate programs whose prepa- ration included a preceptorship were more likely to provide primary care than graduates whose preparation did not. Graduates of master’s degree programs who experienced a preceptorship were only slightly more likely to provide primary care than graduates who did not. On the other hand, graduates of master’s programs which did not require a preceptorship were more likely to accept employment in the nonpractitioner role. History.—Tables 23 to 30 present information on the employment history of nurse practitioner graduates. Length of employment was measured from the date of first employment after graduation to the date the survey questionnaire was completed (table 23). The median length of employment was 15 months. During that time following graduation, 25 percent of the graduates had experienced at least one employment change (table 24). Of those who did change their employment, almost STUDY FINDINGS 15 three-quarters were employed at the time of the survey. The reasons cited for changing jobs are presented in table 25. Of those who were not employed, the most frequently given reason was family responsibilities. Only 30 percent of the graduates who were not employed cited lack of opportunity to use new skills as a reason for not being employed. Among those who were employed at the time of the survey, a large proportion of the graduates of both types of programs indicated that they changed jobs as a result of-a better opportunity to use their new skills. Table 26 provides the distribution of months between graduation and initial employment. Three—quarters of the combined graduates of certifi- cate and master’s programs were employed within a month of gradua— tion. In fact, only 10 percent of the graduates waited more than 3 months to achieve employment. Graduates of master’s programs required some- what more time than graduates of certificate programs to gain employ- ment following graduation. This was probably because they were much less likely to have guaranteed employment before, entering their NP programs and because they were not as likely to return to the same setting after their preparation. In table 27 it can be noted that almost half of the graduates of certificate programs returned to the same setting in which they were employed prior to nurse practitioner preparation. However, this was true for only 14 percent of the graduates of master’s programs. As would be expected, less time elapsed between graduation and employment for those who returned to the same setting in which they were employed prior to preparation than for those who were placed in different settings (table 28). Although not presented in a table, the data reveal that the period of time from the end of the job held prior to nurse practitioner preparation until commencing employment following graduation was 1 year or less for 89 percent of the graduates of certifi- cate programs and 2 years or less for 93 percent of the graduates of master’s programs. These differences were primarily the result of varia- tions in program length rather than difficulties in finding employment. The reasons for unemployment provided at the time of the survey are listed in table 29. It is important to note that a large proportion of those nurse practitioner graduates who were not employed were not actively seeking employment. Income.—The source of practically all nurse practitioner income was salary rather than fee-for-service or a share of practice receipts. Tables 31—43 and figure 2 present data on income. As indicated in table 31, the average, gross, annual income of graduates employed full time ranged between approximately $12,400 and $15,300, depending upon specialty and type of nurse practitioner program. Overall, the average income of graduates of master’s programs was approximately $1,000 per year more than the average income of graduates of certificate programs. The two exceptions were pediatric and family nurse practitioners. There appears 16 STUDY PHASE II to be no difference in salary between graduates of certificate programs and graduates of master’s programs in these specialities. The distribution of graduates by income is shown in table 32 and the distribution by income and by specialty is shown in table 33. Not shown on a table is the fact that about one-quarter of the graduates employed in nonhospital institutional settings (mainly schools and college health programs) were in the lowest income category ($6,000 to $10,000 per year) possibly because many of them were on 9- or 10-month appointments. Such settings accounted for twice as many low-income graduates as any of the other settings. Salaries varied by whether or not graduates were employed as nurse practitioners (table 34). The average salary of graduates of certificate and master’s programs not employed as nurse practitioners was lower than that of both groups of graduates who were employed as nurse practitioners. Graduates employed as nurse practitioners and providing primary care had somewhat lower average incomes than graduates who were teaching and consulting. Average income varied by geographic region (tables 35—36). The vari- ations in nurse practitioners salaries by geographic region were com- pared with similar variations in salary among State-employed registered nurses.1 Although the differences between nurses’ salaries and nurse practitioners’ salaries were fairly constant across the United States, ranging from $2,000 to $3,500, nurse practitioners showed the greatest income advantages over State-employed nurses in the Northeastern States. State-employed nurses in the Western States had higher incomes than their counterparts elsewhere. Consequently, the increase in income achieved by graduates of nurse practitioner programs was smallest in the Western States. Average income by practice setting location is shown in table 37. The incomes of graduates employed in settings located in the inner city (which accounted for the majority of nurse practitioners) were midway between the incomes of graduates employed in settings located in rural areas and in the suburbs. Average income in rural practice settings was lower than income in urban or suburban settings. Graduates in suburban settings had the highest incomes. Table 38 compares income before nurse practitioner preparation and after nurse practitioner preparation. The average increases, $4,131 for those with master’s degrees as compared to $2,351 for those with certificates, exceeded the expectations of both groups. More specific presentations with respect to salary change are presented graphically in figure 2 and tables 39 and 40. About 20 percent of the graduates of 1“Survey Shows State-Employed Nurses‘ Salaries Vary Widely, Some are Grossly Inadequate,” American Journal of Numing, 77: 4 (April 1977), p. 556. STUDY FINDINGS 17 Figure 2.—Graduates employed full time, by percentage distribution of actual change in income and type of NP program Percent 20 _ CERTIFICATE 10— MASTER'S 20— Decrease No $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 B$7IOOO change Increase 18 STUDY PHASE 11 certificate programs and only about 6 percent of graduates of master’s programs did not receive salary increases. In phase 1 of the study, former nurse practitioner students were asked what they anticipated in increased income upon completion of their nurse practitioner programs. Table 41 shows the anticipated increases in com— parison to the actual increases for the graduates who were employed on a full—time basis. Students in master’s programs had much higher expec- tations for increases than students in certificate programs ($3,519 as compared to $1,271). The actual increases achieved by nurse practi- tioners graduated from certificate programs exceeded their expectations by $1,080, whereas the actual increases achieved by nurse practitioners graduated from master’s programs exceeded their expectations by $612. It appears, therefore, that students in master’s programs were more precise in estimating their postgraduation income than students in cer- tificate programs, who did not expect the amount of improvement in income that actually occurred. In table 42 the anticipated increase was compared to the actual increase in income by prior nursing preparation. Graduates of certificate programs, whose prior nursing preparation was a baccalaureate or mas— ter’s degree, expressed very modest expectations. By comparison, their actual increases appeared substantial. With only one exception, gradu- ates of master’s degree programs also received higher increases than expected. The amount of the salary increase was related to employment status in table 43. Those graduates employed but not as nurse practitioners received the lowest average salary increases. This was true for graduates of both certificate and master’s programs. STUDY FINDINGS 19 Aspects of NP Practice The findings reported in the remainder of this presentation are related to the subgroup of the respondent universe employed as nurse practi- tioners. Setting—Overall, nurse practitioners worked in an average of 1.4 employment settings. Nurse practitioners graduated from master’s pro- grams were employed in slightly more settings, on the average, than nurse practitioners graduated from certificate programs, 1.8 compared to 1.3. During the course of the survey, each nurse practitioner was asked to identify the single work setting in which she spent most of her time as a nurse practitioner. Therefore, information regarding work settings in subsequent tables refer in many cases only to one of the settings in which an individual nurse practitioner may work. Table 44 illustrates the employment settings in which nurse practi- tioners spent most of the time that they were employed as nurse practitioners. Nearly two-thirds of the nurse practitioners were in am- bulatory clinical settings, primarily in hospital— or community-based clinics. An additional 16 percent were in nonhospital institutional set- tings, mainly college health programs or public school systems. Ten percent were in nonhospital community settings such as health depart- ments or home health agencies. There were some interesting differences between nurse practitioners from certificate programs and nurse practi- tioners from master’s programs. Although both groups were likely to spend most of their time in ambulatory practice settings, a much larger proportion of nurse practitioners prepared in certificate programs than nurse practitioners prepared in master’s programs were in nonhospital institutional settings. On the other hand, the proportion of nurse practi- tioners from master’s programs employed in inhospital practice (i.e., inpatient service unit) was more than twice that of nurse practitioners from certificate programs. Extended care facilities accounted for very few nurse practitioners. The average number of hours per week nurse practitioners functioned as nurse practitioners in specific employment settings is shown in table 45. Overall, nurse practitioners graduated from both certificate and master’s programs spent an average of 34 hours per week functioning as nurse practitioners. It appears that some nurse practitioners spent only a portion of their working time in one employment setting. Nurse practi- tioners employed in ambulatory practice and nonhospital institutional settings did not, as a rule, divide their time between several settings. On 20 STUDY PHASE II the other hand, nurse practitioners employed in inpatient practices, extended care facilities, and schools of nursing were very likely to divide their time among two or more settings. Table 46 provides a distribution of practice setting locations according to the respondents own classifications of themselves. One-third of the total group of nurse practitioners was employed in inner-city areas. The specialties most likely to be represented in inner-city locations were pediatrics, midwifery, and maternity (table 47). Nineteen percent of the nurse practitioners graduated from certificate programs as compared to 7 percent of the nurse practitioners graduated from master’s programs were located in’rural settings. Family nurse practitioners were the most likely of all the specialties to be represented in rural locations. It should be noted that over 80 percent of the locations labeled “rural” had populations of fewer than 10,000; over 85 percent of the locations labeled “inner city” had populations of 100,000 or more; 66 percent of the locations labeled “other urban” had populations of 100,000 or more, and 78 percent of the locations labeled suburban had populations of 30,000 or more. The variation in the distribution of nurse practitioner practice settings by geographic region and type of location reflects both employment opportunity and the type of nurse practitioner preparatory program most common in the area (table 48). For instance, graduates of master’s programs in the Midwest were more likely to work in inner-city settings than similar graduates elsewhere in the country. Conversely, graduates of certificate programs were most likely to find employment in the inner cities of the Northeast. Rural settings throughout the United States have attracted to a far greater degree graduates of certificate programs than graduates of master’s programs. Table 49 is a presentation of the practice setting location by employ- ment setting. Almost all types of employment settings are well repre- sented in inner-city areas. A substantial number, one-quarter of all nurse practitioners, were employed in ambulatory practice in inner cities. The second largest single category of nurse practitioners was employed in ambulatory settings in rural locations. Over half of the nonhospital institutional settings involve military installations, VA hospitals, in- dustry, or college and university campuses. Table 50 shows the propor- tion of patients within specific income categories being served by the practices in which nurse practitioners were employed. Overall, 53 per- cent of patients served were in the group whose income was less than $4,000 per year, and 38 percent of patients served were in the group whose income was from $4,000 to $15,000 per year. Among those patients served by midwives, the highest proportion was in the low-income group. Not shown on a table is the fact that only 7 percent of nurse practitioners prepared in certificate programs and only 11 percent of nurse practi- STUDY FINDINGS 21 tioners prepared in master’s programs were employed in settings which did not serve low-income patients at all. On the other hand, for as many as one quarter of nurse practitioners graduated from both certificate and master’s programs, 80 percent and more of their services were provided to low—income patients. Overall, 62 percent of the group of nurse practitioners were the first nurse practitioners to work in a specific practice setting (table 51). Family and adult nurse practitioners were more commonly the first nurse practitioner in the setting. More than 60 percent of all practices employ- ing nurse practitioners had provided patient care for over 5 years (table 52). Nurse practitioner positions had been planned in more than one- quarter of the practices at the time the practice was established (table 53). Planning for a nurse practitioner position was directly related to the number of years that the practice had existed. More than two-thirds of the practices which had been providing patient care for less than a year had planned a nurse practitioner position when the practice was estab- lished (table 54). Tables 55 and 56 deal with the nurse practitioners’ titles in their employment settings. Function.-—Tables 57—89 describe various aspects of nurse practi- tioner employment. This series of tables provided data on role; provision of primary care; relative allotment of time to various aspects of nurse practitioner roles, functions, and settings; the kinds of health care services nurse practitioners provided; the nature of the patient popula- tions being served; the relationships between nurse practitioners pre- pared to provide specific services and whether or not they did; the distribution of nurse practitioners among practices providing particular types of care; the average number of patients nurse practitioners saw per day; who in the practice saw new patients and who saw patients on followup visits; availability of physicians for nurse practitioner consulta- tion; frequency that a preceptor reviewed nurse practitioner records; and supervision of nurse practitioners. Tables 57 and 58 detail the functions that nurse practitioners per- formed and the average hours per week spent on each. Since many nurse practitioners combined the nurse practitioner and nonpractitioner nurs- ing roles, the data are presented in these terms. The categories of nurse practitioner functions are not mutually exclusive. Almost all nurse prac- titioners prepared in certificate programs and 90 percent of nurse prac— titioners prepared in master’s programs who were engaged exclusively in the nurse practitioner role provided some primary care. More specific- ally, nurse practitioners from certificate programs spent 87 percent of their time providing primary care (34 hours of a total of 39). Nurse practitioners from master’s programs were primarily involved in provi- sion of primary care and secondarily in teaching. These two functions occupied 87 percent of their time (37 hours of a total of 42). The great 22 STUDY PHASE II majority of nurse practitioners engaged in a combination of the nurse practitioner and nonpractitioner nursing roles provided some primary care but this function accounted for less than half of their time. More specifically, for nurse practitioners from certificate programs, the most nonpractitioner time was spent as a staff nurse. For nurse practitioners from master’s programs, the most nonpractitioner time was spent as a teacher. Table 59 illustrates selected combinations of functions performed by nurse practitioners. Over half of the nurse practitioners graduated from certificate programs and slightly more than one-fourth of the nurse practitioners graduated from master’s programs were involved in pri- mary care only. Nurse practitioners from master’s programs were more likely than nurse practitioners from certificate programs to provide primary care in combination with other functions, especially teaching. Three percent of the nurse practitioner graduates of certificate programs compared to 16 percent of the nurse practitioner graduates of master’s programs provided no primary care. Of those nurse practitioners who were prepared in master’s programs and did not provide primary care, more than one-half were involved in teaching only. Table 60 shows the relationship between the provision of primary care in the nurse practitioners’ current positions and the provision of direct patient care in their positions before nurse practitioner preparation. Nurse practitioners from certificate programs who provided direct pa— tient care before their nurse practitioner preparation were more likely than those who did not do so to provide primary care in their current positions. This was not so for nurse practitioners from master’s pro- grams. The majority of nurse practitioners, but those in the midwifery specialty more than any other, worked full time in nurse practitioner functions (table 61). Sixty-one percent of nurse practitioners were employed exclusively as nurse practitioners (table 62). The remaining ones divided their time between the nurse practitioner and nonpractitioner roles in a variety of ways. Nurse practitioners who spent all of their time in nurse practi- tioner functions were more likely than those who did not to be employed in ambulatory or inhospital practices (table 63). Nurse practitioners who spent only a fraction of their time in nurse practitioner functions were more likely than those devoting full time to nurse practitioner functions to be employed in nonhospital institutional or community settings. Table 64 presents information on the kinds of health care services provided by nurse practitioners. As would be expected, specialty was the determining factor in the type of health services provided. A combination of services was most frequently provided by nurse practitioners in ambulatory practices (table 65). Infant and child health care was most frequently provided by nurse practitioners in nonhospital community settings. STUDY FINDINGS 23 Tables 66, 68, and 70 reveal information about the ways nurse practi- tioners who provided certain kinds of services functioned. The alter— nately numbered tables, 67, 69, and 71, provide information on the amount of physician consultation nurse practitioners required in per- forming those functions. Both the proportion of those who performed specific functions and the percent of physician consultation varied with the nature of the function. In general, except for nurse practitioners providing maternity care, nurse practitioners from master’s programs were less likely than nurse practitioners from certificate programs to perform many of the functions, but when they did perform them, they required less physician consultation. Table 72 addresses the question: What proportion of nurse practi- tioners were actually providing services in those health care areas for which they were prepared? Ninety—five percent of nurse practitioners prepared to provide adult health care were actually providing that type of care. On the other hand, 76 percent of those prepared in infant and child care and 62 percent of those prepared in maternity care/family planning actually provided those types of care. Nurse practitioners prepared in certificate programs to provide infant and child care or adult health care were more likely to be providing these kinds of services than were nurse practitioners from master’s programs. Nurse practitioners prepared in master’s programs to provide maternity/family planning services more frequently provided them than nurse practitioners pre- pared in certificate programs. Substantial proportions of nurse practi- tioners in midwifery, maternity, and family care specialties were pre- pared to provide infant and child health care. Yet they were not doing so. Table 73 addresses the question: Of those nurse practitioners providing specific services, how many were specifically prepared by their educa- tional programs to do so? More than three-fourths of those nurse practi- tioners providing services in each of the three areas were prepared by their nurse practitioner education to provide such services. Nurse prac- titioners prepared in master’s programs and providing adult health or maternity care/family planning were more likely than their counterparts from certificate programs to have been prepared to provide such ser— vices. On the other hand, nurse practitioners prepared in certificate programs were more likely than nurse practitioners prepared in master’s programs to have been prepared to provide the infant and child health care they were providing. Again there were mismatches between prepa- ration and actual provision of services. For example, nurse practitioners graduated from certificate-level pediatric programs provided maternity care without having been prepared by the program itself to do so, or nurse practitioners graduated from certificate-level maternity programs provided infant and child care without having been prepared to do so. Tables 74—83 present the proportions of nurse practitioners providing 24 STUDY PHASE 11 selected types of care to specific categories by patients by nurse practi- tioner specialty. Since relatively small numbers are involved for some specialties, the data should be interpreted with caution. Psychiatric nurse practitioners are not represented since the nature of their practice precludes their involvement in many of these activities. These findings illustrate the fact that nurse practitioners prepared in specific areas may in certain practice circumstances be required to provide services to populations not usually considered within their specialty preparation. Table 84 shows the average number of patients nurse practitioners saw per day in the employment setting in which they spent most of their time functioning as nurse practitioners. Nurse practitioners prepared in cer- tificate programs, as a group, saw more patients per day than nurse practitioners prepared in master’s programs. There were also differences by specialty. Sixty-eight percent of family nurse practitioners, 60 per- cent of maternity and adult nurse practitioners, and only 44 percent of pediatric nurse practitioners saw more than 10 patients per day. It should again be emphasized that many nurse practitioners worked in more than one setting. The number of patients seen per day reported for the one setting in which each nurse practitioner worked most of the time might have been only a fraction of the total number of patients seen per day in two or more settings. Thus, these data do not allow for conclusions to be drawn as to the total daily productivity of nurse practitioners. A presentation of the discipline of the persons in the practice who saw new patients and patients on followup visits appears in table 85. More than 30 percent of nurse practitioners prepared in certificate programs compared to only 15 percent of nurse practitioners prepared in master’s programs were the persons in the practice who usually saw new patients. Nurse practitioners prepared in certificate programs were only slightly more likely than nurse practitioners prepared in the master’s programs to see patients on followup visits. The physician and nurse practitioner were somewhat more likely to be both involved in seeing new patients than to be both involved in followup visits. One-third of the nurse practitioners reported that a physician was always available—actually physically present—to discuss patient prob- lems as they occurred (table 86). An additional 46 percent were always available by phone when they were not physically present. Nurse prac— titioners employed in inhospital practice settings were more likely than nurse practitioners in other settings to have reported that a physician was always physically present during the time that they were functioning as nurse practitioners (table 87). Ninety-five percent of the group of nurse practitioners reported that a physician or nurse preceptor re- viewed their records with the frequency ranging from “always” to “seldom” (table 88). The records of nurse practitioners from certificate programs were reviewed somewhat more frequently than those of nurse STUDY FINDINGS 25 practitioners from master’s programs. Fewer than 5 percent of the group indicated that their records were never reviewed. The final table in this section deals with nurse practitioners’ opinions as to the ideal length as compared to the actual length of each curricular component of their nurse practitioner preparation (table 89). On the average, nurse practitioners prepared in certificate programs viewed the didactic portion as too short and nurse practitioners prepared in master’s programs viewed it as too long. On the other hand, both groups thought the internship was too short. The nurse practitioners graduated from master’s programs considered substantial internships as ideal when in fact their program did not provide one or required relatively brief internship experiences. Nurse Practitioner Motivation; Consequences—Tables 90 and 91 present information on nurse practitioners’ reasons (and also the most important reason) for choosing their current employment. The two most frequently cited reasons were role autonomy and the desire to be in a setting which offered a creative approach to health care delivery. Nurse practitionersgraduated from master’s programs ranked role autonomy as of prime importance whereas nurse practitioners graduated from certificate programs ranked a creative approach to health care delivery as most important. Nurse practitioners employed in suburban settings were more likely to cite role autonomy as the most important reason, whereas nurse practitioners employed in rural settings were more likely to report that their current position offered a more creative approach. (This information is not shown in a table.) Employer Motivation.—As was described previously, employers or supervisors of those graduates functioning as nurse practitioners and providing primary care were surveyed. Fifty-seven percent of the group of employer or supervisor respondents were physicians and 24 percent were nurses (table 92). The foregoing table reflects both nurse practitioner selection in choos- ing someone to answer the employer or supervisor questionnaire and the effect of some nonresponse. In reality, there were far more complicated supervisory arrangements than are reflected in table 92. A physician was the only supervisor for 80 percent of the nurse practitioners providing primary care. A combination of a physician and a nurse practitioner was the supervisor for another 10 percent. Depending on the type of em— ployment setting, the average number of physicians in a given setting ranged from three to nine. The average number of nurse practitioners in a given setting was smaller than that for physicians, ranging from two to five. There was no physician in only 4 percent of the employment settings and all of these settings were those in which nurse practitioners gradu- ated from certificate programs were employed. The employers’ reasons and the most important reason for employing 26 STUDY PHASE II the nurse practitioner are presented in tables 93 and 94. Over one—half of the employers indicated that among the most important reasons were those related in general to the improvement of quality. Within that category, 43 percent employed the nurse practitioner to allow physicians to spend more time on complex cases and 23 percent employed the nurse practitioner to increase the amount of patient education provided. Rea— sons related in general to the desire to extend services to more persons were cited by almost 38 percent of employers. Within that category, providing care for patients previously uncared for was the most fre— quently indicated reason. Other reasons within this same general cate- gory, including increasing cost effectiveness of the practice, were not frequently cited. Tables 95 and 96 present employers’ impressions of effects (and also the most significant effect) of employing the nurse practitioner. Employers’ impressions of the most significant effect of employing the nurse practitioner were consistent with their most impor- tant reasons for employing the nurse practitioner (table 97). Employers reported that the nurse practitioners had an effect upon improvement of quality of care and extension of services to more persons. For 80 percent of the responses, reasons for employing nurse practitioners correspond to the effects of their employment (table 98). Table 99 reveals the employers’ impressions of changes in the practice that resulted from the employment of nurse practitioners. Most fre- quently cited were changes in the pattern of flow of patients through the practice. Nenty—eight percent of the employers reported no change in any respect. In general, the same pattern of change occurred whether the nurse practitioner was a graduate of a certificate or a master’s program. The data in table 100 reflect further the employers’ very positive reactions to the nurse practitioners. Ninety-two percent of the employers reported that the benefits of employing the nurse practitioner out- weighed the costs. Data not shown in a table reveal that all of the 38 employers or supervisors who were themselves nurse practitioners be- lieved that benefits outweighed costs. Ninety-one percent of other em- ployers were in agreement with this opinion. About two-thirds of those very few employers who reported that benefits of employing the nurse practitioner did not outweigh costs cited as a reason that the nurse practitioner’s time was not filled to maximum productivity (table 101). These 31 employers who had a negative opinion of nurse practitioner benefits cited an average of two reasons upon which to base their opinions. They were less likely than other employers to cite improved quality of care as a result of employing the nurse practitioner but more likely to cite extended services to more persons. (This information is not shown on a table.) Acceptance; Barriers—Findings in tables 102—104 indicate that the STUDY FINDINGS 27 nurse practitioner role was well accepted by patients, other health workers, support personnel, and people in the community. The impres- sions of the degree of acceptance as perceived by employers and nurse practitioners were highly consistent. In general, nurse administrators and pharmacists were more likely than others to be perceived as not accepting the role. However, the negative response was minimal. Tables 105 and 106 suggest that nurse practitioners were more likely to perceive role barriers than their employers, but both groups identified essentially the same kinds of barriers. Legal restrictions, limitations of space or facilities, resistance from other health providers within and outside the practice, and lack of appropriate job classifications were the barriers most frequently cited by both nurse practitioners and employ- ers. About one—quarter of the employers and 10 percent of the nurse practitioners expressed the opinion that there were no role barriers. The percent of nurse practitioner agreement with employers regarding bar- riers is presented in table 107. Satisfaction—Tables 108—117 and figure 3 are concerned with satis- faction. The nurse practitioners’ general satisfaction with their positions is shown in table 108. Two-thirds of the nurse practitioners from certifi- cate programs and more than half of the nurse practitioners from master’s programs were very satisfied. Only 6 percent of the total group was actually dissatisfied to any degree. Variations in satisfaction with specific aspects of their present positions is revealed in table 109. The areas of dissatisfaction, expressed by more than one-quarter of the nurse practitioners, was with the administrative climate within the setting, pay and benefits, and time spent on nonprofessional tasks. It is apparent from data in table 110 that satisfaction was only very slightly related to income. Employer satisfaction with nurse practitioners is a critical factor in their future success in the marketplace. Table 111 presents the employers’ degree of general satisfaction. Eighty—five percent of the employers were very satisfied with the nurse practitioners. Dissatisfac- tion was minimal. Table 112, which presents information on employer satisfaction with specific aspects of nurse practitioner functions, reveals that employers were least satisfied with the adequacy of the nurse practitioner’s productivity. Yet 61 percent of the employers were very satisfied with the nurse practitioner’s productivity. The nurse practi- tioner’s prior nursing preparation and the length of the nurse practitioner program had practically no relationship to employer satisfaction (tables 113 and 114). Employers’ degree of satisfaction was correlated with nurse practi— tioners’ degree of satisfaction in table 115. N0 hundred twenty-six or 56 percent of employer-nurse practitioner pairs were very satisfied and more than 91 percent were at least somewhat satisfied. Tables 116 and 117 and figure 3 show the level of nurse practitioner 28 STUDY PHASE II satisfaction as expressed in terms of selected job characteristics adopted from a questionnaire by Bellinger.2 In table 116, job satisfaction in the prior nursing position and student expectations of the nurse practitioner role are compared to satisfaction in the present nurse practitioner position. Figure 3 reveals that on the average the expectations of three-quarters of the nurse practitioners in certificate programs and two-thirds of the nurse practitioners in master’s programs are realized in their present positions. It should be noted that the mean satisfaction is at a level of 5.6 on a scale of one to seven. Job satisfaction is related to prior nursing preparation in table 117. Nurse practitioners prepared in both certificate and master’s programs differed very little in job satisfaction on the basis of their prior preparation. Figure 3.—-Average job satisfaction of NPs as exemplified by attainment in prior nursing position, expectation as an NP, and attainment in the present position, by type of NP program (max) 7 F- \\\\\\\\\\\\\\\\\\\\\\\\\‘ W s\\\\\ W W (min) 0 7‘! CERTIFICATE MASTE Prior n ursing position W Expectation as NP m Present NP position 2Arnold Bellinger, Ph.D., Wayne State University. S SUMMARY It should be readily apparent that great volumes of data have been abstracted for the purpose of this document. As a result, any in-depth interpretation of specific findings will be published separately. Several conclusions, however, are indisputable. First, the nurse practitioner movement is alive and well and flourishing throughout the United States. It is moving significant numbers of primary care providers into the disadvantaged urban and rural areas. Second, those who employ nurse practitioners are generally well satisfied with their performance and are especially pleased with the consequences of their employment. Nurse practitioners have not only improved the capability of the setting to deal more efficiently with more patients but they have also produced con- structive changes in the ability of the service to provide better care. The income of nurse practitioners after graduation generally exceeds their prior expectations and the nurse practitioners have achieved a degree of satisfaction with their role that exceeds that in their prior work settings. Third, the acceptance of nurse practitioners by other profes— sionals and patients has been reported to be exceptionally high. These positive findings, however, should not distract attention from the problem areas. There are still barriers to the employment of nurse practitioners. There are real or perceived legal obstacles, lack of planning for nurse practitioner activity in facility design, and probably most important, lack of understanding and resistance on the part of physi- cians. Although those physicians who employ nurse practitioners evi- dence enthusiasm for their contribution, there must be significant numbers of physicians who view the nurse practitioner movement as a threat to the status of medical practice as it presently exists. If, indeed, the thrust of health care is to improve the accessibility of primary medical care, then these data support the conclusion that the nurse practitioner movement is now serving and will continue to serve that objective. Although there are some mismatches between prior preparation and subsequent function and some questions about the duration and content of appropriate nurse practitioner preparation, they represent issues which can be resolved among the educational institu- tions with some concerted effort. The image of the nurse practitioner movement among physicians who have so much influence over the mar- ketability of nurse practitioner graduates is a broader and more difficult problem. Only through the wide dissemination of the positive findings regarding the benefits to the public and the medical profession of nurse 29 3O STUDY PHASE II practitioner employment and some unification of purpose within the nursing profession itself regarding the role of nurse practitioners will the movement have its greatest impact. The result will be a medical care system with a vastly improved capability for delivery of primary medical care in an efficient and effective manner. TABLES 31 Table 1.—NP programs, phase 1 student respondents, and phase 2 respondents, by specialty and type of NP program Programs Phase 1 Responding Represented student Phase 2 in phase 1 in phase 21 respondents2 respondents Specialty No. No. Pct. No. No. Pct. Certificate Pediatric ___________________ 42 39 92.8 350 239 68.3 Midwifery _________________ 5 3 60.0 26 15 57.7 Maternity __________________ 7 7 100.0 60 40 66.7 Family ________ _ ____ 17 17 100.0 185 125 67.6 Adult ____________ 15 15 100.0 172 116 67.4 Total _____________________ 86 81 94.2 793 535 67.5 Master’s Pediatric ___________________ 8 5 62.5 30 21 70.0 Midwifery __ 6 6 100.0 53 38 71.7 Maternity ________________ 7 6 85.7 30 19 63.3 Family ______________________ 12 12 100.0 100 70 70.0 Adult ._______ 8 8 100.0 66 50 75.8 Psychiatric ______________ 4 4 100.0 27 20 74. 1 Total _____________________ 45 41 91.1 306 218 71.2 Total Pediatric __________________ 50 44 88.0 380 260 68.4 Midwifery _________________ 11 9 81.8 79 53 67.1 Maternity ________ ____ 14 13 92.8 90 59 65.6 Fami1y_____ ____‘_ 29 29 100.0 285 195 68.4 Adult _______________ 23 23 100.0 238 166 69.7 Psychiatric _______________ 4 4 100. 0 27 20 74. 1 Total ___-_____________--__ 131 122 93. 1 1,099 753 68. 5 ‘Programs were not queried for phase 2. Only those programs from which at least one former NP student responded in phase 2 were included. 2Two respondents from phase 1 did not identify themselves and are excluded from phase 2. 32 STUDY PHASE II Table 2.—Selected demographic characteristics of phase 2 respondents and nonrespondents Respondents Nonrespondents Total Demographic characteristics1 No. Pct. No. Pct. N o. Pct. Sex Male _____________________________ 14 1.9 8 2.3 22 2.0 Female __________ 739 98. 1 338 97. 7 1,077 98.0 Total __________________________ 753 100.0 346 100.0 1,099 100.0 Ethnic self-description Caucasian _____________________ 690 92.2 291 85. 1 981 90.0 Black American-________-______ 38 5.1 36 10.5 74 6.8 Oriental _______________________ 14 1.9 5 1.5 19 1.7 American Indian ___ 2 .3 1 .3 3 .3 Mexican American ____________ 3 .4 6 1.8 9 .8 Puerto Rican _________________ 1 .1 1 .1 Latin American _____ 3 .8 3 .3 Total2 _________________________ 748 100.0 342 100.0 1,090 100.0 Marital status Unmarried ____________________ 335 45.1 150 44.1 485 44. 8 Married _________________________ 408 54.9 190 55.9 598 55.2 Total3 __________________________ 743 100.0 340 100.0 1,083 100.0 Age (in years) <25 _____________________________ 21 3.1 12 3.9 33 3.3 25—34 _______________________ _ 363 53.1 165 53.7 528 53.3 35—44 __________________ 181 26.5 78 25.4 259 26.2 45—54 ___________________ 94 13.8 45 14.7 139 14.1 >55 _________________________ 24 3.5 7 2.3 31 3.1 Total“1 ________________________ 683 100.0 307 100.0 990 100.0 Region of program5 West ___________________________ 201 26.7 ' 73 21.1 274 24.9 Midwest__ __________ 139 18.5 64 18.5 203 18.5 Northeast ____________ 205 27.2 111 32. 1 316 28.8 South __________________ 208 27.6 98 28.3 306 27.8 Total ______________________ 753 100.0 346 100.0 1,099 100.0 1Information for this presentation was obtained during phase 1. 2Five respondents and four nonrespondents did not supply information on ethnic self»description during phase 1. 3Ten respondents and six nonrespondents did not supply information on marital status during phase 1. ‘Seventy respondents and 39 nonrespondents did not supply information on age during phase 1. 5Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the NP programs. TABLES Table 3.—Selected professional characteristics of phase 2 respondents and 33 nonrespondents Respondents Nonrespondents' Total Professional characteristics1 No. Pct. No. Pct. No. Pct. Years in professional nursing 0 ___________________ 17 2.3 10 2.9 27 2.5 1—5 ___________________________ 272 36.5 119 34.5 391 35.9 6—10 ______________________ 199 26.7 101 29.3 300 27.5 11—15____. __________________ 119 16.0 47 13.6 166 15.2 16—20 __________________________ 72 9.7 42 12.2 114 10.5 >20_.___..___.___ ______ 66 8.8 26 7.5 92 8.4 Total2 ______________________ 745 100.0 345 100.0 1,090 100.0 Prior nursing preparation Hospital diploma ____________ 252 33.5 129 37.4 381 34.7 Associate degree _ _____ __ 41 5.4 31 9.0 72 6.5 Baccalaureate degree ________ 409 54.3 176 51.0 585 53.3 Master’s degree ______________ 51 6.8 9 2.6 60 5.5 Total3_____ ____ 753 100.0 345 100.0 1,098 100.0 Degree obtained in field other than nursing None _________________ 677 89.9 321 93. 1 998 90.9 Associate degree ____________ 9 1.2 9 .8 Baccalaureate degree ____ 42 5.6 16 4.6 58 5.3 Master’s degree _____________ 22 2.9 7 2.0 29 2.6 Doctoral degree __________ 1 .1 1 .1 Other‘____. ________________ 2 .3 1 .3 3 .3 Total6 _________________ 753 100.0 345 100.0 1,098 100.0 Employment status Employed as NP6 ___________ 532 70.3 238 88.1 770 75.3 Employed, not as NP ______ 122 16.1 21 7.8 143 14.0 Not employed ________________ 70 9.2 7 2.6 77 7.5 Not graduated _________ _ 27 3.6 4 1.5 31 3.0 Deceased _________ ..__ 2 .8 2 .2 Total" _____________________ 753 100.0 270 100.0 1,022 100.0 Number of years in job just prior to entering NP pro- gram <2.._-___. _______________ 203 28.2 83 25.2 286 27.2 2_ _____________________________ 194 27.0 90 27.4 284 27.1 3—5 _-__________ ______ 162 22. 5 72 21. 9 234 22.3 6—10 __________________________ 103 14.3 51 15.5 154 14.7 11—15_______________.-__ 39 5.4 27 8.2 66 6.3 >15 _______________ 19 2.6 6 1.8 25 2.4 Total8 ___________________ 720 100.0 329 100.0 1,049 100.0 1With the. exception of employment status, information for this presentation was obtained during phase 1. 2Eight respondents and one nonrespondent did not supply information on the number of years in professional nursing during phase 1. 3One nonrespondent did not supply information on prior nursing preparation during phase 1. ‘ Other includes preparation not leading to a degree. 6One nonrespondent did not supply information on prior education during phase 1. 6Included in this category are respondents functioning wholly or in part as NPs. 7The employment status of 77 nonrespondents could not be ascertained during phase 2 from program directors. SNenty—five respondents and 12 nonrespondents were not employed just prior to entering the NP program. Eight respondents and five nonrespondents did not supply information on the number of years in the job just prior to entering the NP program. Table 4.—Responding employers, by specialty and type of NP program Employers expected and responding and type of program Certificate Master’s Total Expected 1 Responding Expected 1 Responding Expected 1 Responding Specialty No. No. Pct. No. No. Pct. No. N o. Pct. Pediatric 172 133 77.3 7 6 85.7 179 139 77.7 Midwifery 9 8 88.9 25 19 76.0 34 27 79.4 Maternity 26 21 80.8 4 4 100.0 30 25 83.3 Family 102 90 88.2 44 36 81.8 146 126 86.3 Adult 94 81 86.2 14 13 92.9 108 94 87.0 Psychiatric - -- -- 3 3 100.0 3 3 100.0 Total 403 333 82.6 97 81 83.5 500 414 82.8 ‘Erpected represents the number of employers of responding NPs who provided primary care. Responses from 11 employers were excluded from this distribution and all subsequent presentations because the corresponding NPs did not respond. II HSVHcI ACIDLS f8 TABLES 35 Table 5.—Regional locationl of graduates, by type of NP program Type of program Percentage distribution Certificate Master’s Total2 of population3 Region No. Pct. No. Pct. No. Pct. Pct. West ____________________ 149 28.8 45 22.5 194 27.1 17. 1 Midwest ______________ 97 18.8 35 17.5 132 18.4 27.9 Northeast ______________ 137 26.5 57 28. 5 194 27. 1 24.8 South ____________________ 134 25.9 63 31.5 197 27.4 30.2 Total _________________ _. 517 100.0 200 100.0 717 100.0 100.0 1Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the graduates when they completed questionnaires in phase 2. 2Three graduates of certificate programs and four graduates of master’s program were located in foreign countries. 3Population percentages are based on 1970 census. Table 6.—-Regional location‘ of graduates, by specialty and type of NP program Region Specialty and West Midwest Northeast South Total type of program Pct. Pct. Pct. Pct. No. Pct. Pediatric Certificate _________________ 26.1 24.4 22.6 26.9 234 100.0 Master’s _____________________ 31.6 5.3 36.8 26.3 19 100.0 Subtotal ______________ _ 26.5 22.9 23.7 26.9 253 100.0 Midwifery Certificate ________-_________ 6.7 13.3 26.7 53.3 15 100.0 Master’s ______ 19.4 41.8 19.4 19.4 36 100.0 Subtotal ________________ 15.7 33.3 21.6 29.4 51 100.0 Maternity Certificate __________________ 28. 9 21.1 10.5 39.5 38 100.0 Master’s _-___ 11. 1 ... 33.3 55.6 18 100.0 Subtotal _________________ 23.2 14.3 17.9 44.6 56 100.0 Family Certificate __________________ 39. 5 12. 6 20.2 27.7 1 19 100. 0 Master’s _________ 27.0 9.5 38. 1 25.4 63 100.0 Subtotal ________________ 35.2 1 1. 5 26.4 26.9 182 100. 0 Adult Certificate _________________ 26.2 13.5 46.8 13.5 111 100.0 Master’s ____-___-_____ 14.3 26. 5 12.3 46.9 49 100.0 Subtotal __________________ 22.5 17.5 36.2 23.8 160 100.0 Psychiatric Certificate _________________ -- -- -- -- -- -- Master’s ___________________ 40.0 46.7 13.3 15 100.0 Subtotal ___-_ 40.0 ... 46.7 13.3 15 100.0 Total2 _____________________ 27.1 18.4 27.1 27.4 717 100.0 ‘Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the graduates when they completed questionnaires in phase 2. ?Three graduates of certificate programs and four graduates of master‘s programs were located in foreign countries. 36 STUDY PHASE II Table 7.—Employment status of graduates, by type of NP program Type of program Certificate Master’s Total Employment status N0. Pct. No. Pct. N 0. Pet. Employed as NP1 Providing primary care __________________ 403 77.5 97 47.6 500 69.0 Teaching, consulting, etc ________________ 12 2.3 20 9.8 32 4.4 Employed, not as NP School of nursing __________________ _ 13 2.5 47 23.0 60 8.3 Inhospital practice, nonhospital insti- tutional and/or community setting, ambulatory practice _____________ __ 38 7.3 24 11.8 62 8.6 Not employed _______________________________ __ 54 10.4 16 7.8 70 9.7 Total ________________________________________ 520 100.0 204 100.0 724 100.0 1Included in this category are respondents functioning wholly or in part as N Ps. Table 8.-—Employment status of NP graduates, by specialty and type of NP program Specialty and type of program Maternity Pediatric Midwifery Family Adult Psychiatric Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Employed as NPl Providing primary care _____________ 172 73.2 9 60.1 26 68.4 102 85.1 94 83.9 —- — 403 77.5 Teaching, consulting, etc. _________ 5 2.1 2 13.3 1 .8 4 3.6 — — 12 2.3 Employed, not as NP ______________ 28 11.9 2 13.3 9 23.7 4 3.3 8 7.1 —— -- 51 9.8 Not employed __ _________________________ 30 12.8 2 13.3 3 7.9 13 10.8 6 5.4 -— —— 54 10.4 Total ----__________ 235 100.0 15 100.0 38 100.0 120 100 0 112 100.0 - — 520 100.0 Master’s Employed as NPl Providing primary care ___________ 7 35.0 25 69.4 4 22.2 44 69.9 14 28.0 3 17.6 97 47.6 Teaching, consulting, etc. ___________ 3 15.0 4 11.1 6 9.5 4 8.0 3 17.6 20 9.8 Employed, not as NP _________________ 8 40.0 5 13.9 11 61.1 7 11.1 29 58.0 11 64.8 71 34.8 Not employed _____________________ _ 2 10.0 2 5.6 3 16.7 6 9.5 3 6.0 16 7.8 Total _________________________________ _ 20 100.0 36 100.0 18 100.0 63 100.0 50 100.0 17 100.0 204 100.0 Total Employed as NPl Providing primary care __-_ _____ 179 70.3 34 66.7 30 53.6 146 79.8 108 66.7 3 17.6 500 69.1 Teaching, consulting, etc. ____ __ 8 3.1 6 11.8 7 3.8 8 4.9 3 17.6 32 4.4 Employed, not as NP ____________ ____ 36 14.1 7 13.7 20 35.7 11 6.0 37 22.8 11 64.8 122 16.8 Not employed ___________ __-- 32 12.5 4 7.8 6 10.7 19 10.4 9 5.6 70 9.7 Total ________________________________ _ 255 100.0 51 100.0 56 100.0 183 100.0 162 100.0 17 100.0 724 100.0 ‘Included in this category are respondents functioning wholly or in part as NPs. Lg szmw. Table 9.—Graduates employed full time and part time, by specialty and type of NP program Specialty and type of program Pediatric Midwifery Maternity Family Adult Psychiatric Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. N 0. Pct. No. ‘Pct. No. Pct. Certificate Full time (>(hrs/wk) __________________ 167 83.1 13 100.0 25 73.5 93 87.7 88 85.4 -- -- 386 84.5 Part time (£35 (hrs/wk) ____________ 34 16.9 9 26.5 13 12.3 15 14.6 -- -— 71 15.5 Total _-_______-________-_-________ 201 100. 0 13 100. 0 34 100. 0 106 100. 0 103 100. 0 -~ —- 457 100. 0 Master’s Full time (>35 (hrs/wk) _________ 16 88.9 24 72.7 13 86.7 54 94.7 43 95.6 15 88.2 165 89.2 Part time (S35 (hrs/wk) ___________ 2 11.1 9 27.3 2 13.3 3 5.3 2 4.4 2 11.8 20 10.8 Total _______________________________ 18 100.0 33 100.0 15 100.0 57 100.0 45 100.0 17 100.0 185 100.0 . Totall Full time (>35 (hrs/wk) ________________ 183 83.6 37 80.4 38 77.6 147 90.2 131 88.5 15 88.2 551 85.8 Part time (£35 (hrs/wk) _____-____ 36 16.4 9 19.6 11 22.4 16 9.8 17 11.5 2 11.8 91 14.2 Total ____.__-___-__.___________-_ 219 100.0 46 100.0 49 100.0 163 100.0 148 100.0 17 100.0 642 100.0 'Nine employed graduates of certificate programs and three employed graduates of master’s programs did not supply information on whether they were employed full time or part time. 11 HSVHd MILLS 88 TABLES 39 Table 10.—Average number of hours per week employed graduates functioned as NPs and not as NPs, by‘employment status and type of NP program Type of program .. Average hours per week No. of —~-—'———“—_ Employment status graduates As NP Not as NP Total Certificate Employed as NP‘ Providing primary care _. _____________________ 403 33.5 6.6 40.1 Teaching, consulting, etc. ___________-________ 10 27.0 7.0 34.0 Employed, not as NP_____-_____-___-__________, ,_ 43 -- 38.4 38.4 Master’s Employed as NP1 Providing primary care ____________________ 97 34.9 7.2 42.1 Teaching, consulting, etc. ___________________ 18 25.2 17.1 42.3 Employed, not as NP _____________________________ 69 -- 43.2 43.2 Total2 Employed as NP1 Providing primary care __________ 500 33.7 6.8 40.5 Teaching, consulting, etc. __ _____ 28 25.8 13.6 39.4' Employed, not as NP _____________________________ 112 -- 41.3 41.3 ‘Included in this utegory are respondents functioning wholly or in part as NPs. 2Ten employed graduates of certificate programs and four employed graduates of master’s programs did not supply information on the hours per week they functioned as NPs, their total working hours, or both. Table 11.—Employed graduates, by role and type of NP program Type of program Certificate Master’s Totall Role No. Pct. No. Pct. No. Pct. NP role only __-_________.__. 257 55.2 67 35.8 324 49.7 Traditional nursing role only_______.__ 51 11.0 71 38.0 1% 18.7 NP role and traditional nursing role _____________..___ 157 33.8 49 26.2 206 31.6 TotaL_______.____.___ 465 100.0 187 100.0 652 100.0 lOne employed graduate of a certificate program and one employed graduate of a master's program did not classify themselves as to role. 4O STUDY PHASE II Table 12.—Selected demographic characteristics of graduates, by employment status Employment status Not Employed employed Total Demographic characteristics No. Pct. No. Pct. N o. Pct. Sex Male -_______._____---__________ 13 92.9 1 7.1 14 100. 0 Female_______.__.__ ______ 641 90.3 69 9.7 710 100.0 Total.._____ 654 90.3 70 9.7 724 100.0 Race White ________ _____ 599 90.1 66 9.9 665 100.0 Black _______— 34 91.9 3 8.1 37 100.0 Other1 _____________-_________._______ 18 94.7 1 5.3 19 100.0 Total2 ________ 651 90.3 70 9.7 721 100.0 Marital status Unmarried____________________________ 295 91.6 27 8.4 322 100.0 Married..____________ 351 89.0 43 11.0 394 100.0 Total3 __.._—___ 646 90.2 70 9.8 716 100.0 Age at graduation (in years) <35.________.__ 360 88.2 48 11.8 408 100.0 35—44 ._..-_.____.._—_ 178 92.7 14 7.3 192 100.0 >45 ___._._--.____.______ 115 94.3 7 5. 7 122 100.0 Total‘ _____________ 653 90.4 69 9.6 722 100.0 Region5 West________.____.______ 175 90.2 19 9.8 194 100.0 Midwest ____________ 118 89.4 14 10.6 132 100.0 Northeast ______________ 176 90. 7 18 9.3 194 100.0 South 180 91.4 17 8.6 197 100.0 TotaL—__________ 649 90.5 68 9.5 717 100.0 ‘Other includes Oriental, American Indian, Mexican American, Poem Riean, and Latin American. 2”l‘hree graduates did not supply infomtion on race. aEight graduates did not supply information on marital status. ”IVVO graduates did not supply information on age. 5Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the graduates when they completed questionnaires in phase 2. Seven graduates were located in foreign countries. TABLES 41 Table 13.—Proportion of graduates who moved from the region of their NP program, by employment status, region of their NP program, and type of NP program Region1 and type of programs West Midwest Northeast South Total Employment status Pct. Pct. Pct. Pct. Pct. Certificate Employed as NF2 Providing primary care- 12.2 13.7 7.4 17.0 12.7 Teaching, consulting, etc.___._____ 33.3 — — -- 8.3 Employed, not as NP __ 13.3 -- 8.3 7.1 7.8 Not employed. _______ __ 9.1 38.5 28.6 25.0 25.9 TotaL ________ __ 12.5 15.3 9.5 16.7 13.5 Master’s Employed as NP2 Providing primary care- 20.0 20.0 25.7 23.5 22.7 Teaching, consulting, etc.__________.. 33.3 - — 16.7 15.0 Employed, not as NP ______ 35.7 20.0 63.0 8.0 35.2 Not employed- __ — 33.3 50.0 50.0 43.8 TotaL_________ 26.8 20.6 37.0 19.6 27.5 Total Employed as NP2 Providing primary care- 13.3 15.3 12.3 17.8 14.6 Teaching, consulting, etc.________-_________._ 3.3 -- —- 12.5 12.5 Employed, not as NP __ 24.1 6.7 46.2 7.7 23.8 Not employed______-__._ 8.3 37.5 33.3 33.3 30.0 Total _____________ __ 15.5 16.7 19.6 17.5 17.4 1Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the NP programs. 2Included in this category are respondents functioning wholly or in part as NPs. 42 STUDY PHASE II Table 14.—Proportion of graduates who moved from the State in which their NP program was located, by employment status, region of their NP program, and type of NP program Region1 and type of program West Midwest Northeast South Total Employment status Pct. Pct. Pct. Pct. Pct. Certificate Employed as NP2 Providing primary care- 28.5 16.4 19.0 36.6 26.3 Teaching, consulting, etc.______.___ 100.0 -— — - 25.0 ' Employed, not as NP-__ 20.0 10.0 33.3 28.6 23.5 Not employed__ ________ _ 36.4 53.9 42.9 37.5 42.6 Total____ _____ _ 29.6 20.4 22.2 35.4 27.7 Master’s Employed as NP2 1 . Providing primary care. 30.0 38.0 51.4 47.0 42.3 Teaching, consulting, etc. __-____ _____ _ 50. 0 -- 42. 9 33. 4 40. 0 Employed, not as NP _____ 42.9 40.0 85.2 28.0 53.5 Not employed..___.__ —- 33.3 50.0 50.0 43.8 TotaL_______-__.__ 36.6 35.3 63.0 37. 5 46.1 Total Employed as NP2 Providing primary care_ 28.7 21.4 27.7 38.0 29.4 Teaching, consulting, etc _______________ _ 66.7 —- 25.0 25.0 34.4 Employed, not as NP __.___ 31.0 20.0 69.2 28.2 41.0 Not employed___ ______ _ 33.3 50.0 44.4 41.6 42.9 TotaL- ______________ _ 31.1 24.2 37.2 36.0 32.9 'Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the NP programs. 2Included in this category are respondents functioning wholly or in part as NPs. TAB LES 43 Table 15.—Selected professional characteristics of graduates, by employment status Employment status Not Employed employed Total Professional characteristics No. Pct. No. Pct. No. Pct. ANA membership Member _____.__________ 316 91.1 31 8.9 347 100.0 Nonmember__________ ______ 335 89.6 39 10.4 374 100.0 Total1 _____ ___________________ 651 90.3 70 9.7 721 100.0 Years in professional nursing None _______________ _____ 12 75.0 4 25.0 16 100.0 1—5 233 90.0 26 10.0 259 100.0 6—‘10 ___________________________ 167 86. 1 27 13. 9 194 100. 0 11—15_______________ 105 92. 1 9 7. 9 1 14 100.0 16—20 ______________-_-_____-_---________-__-_-_- 69 98.6 1 1.4 70 100.0 >20‘___-______________ ______ __ 61 96.8 2 3.2 63 100.0 Tota12'______________.__ 647 90.4 69 9.6 716 100.0 Previous employment setting3 Hospital outpatient service ________ 68 91.9 6 8.1 74 100.0 Hospital inpatient service __ 232 89.6 27 10.4 259 100.0 Health center__._______ ______ 96 95.0 5 5.0 101 100.0 Extended care facility ________________ 11 91.7 1 8.3 12 100.0 Fee-for-service phySician ___________ 30 90.9 3 9.1 33 100.0 Prepaid group practice______.__ 6 85.7 1 14.3 7 100.0 Community/home health agency _______ 100 90.9 10 9.1 110 100.0 School _____________________________ 45 95.7 2 4.3 47 100.0 Teaching ___________ ________ _ 42 89.4 5 10.6 47 100.0 Other‘ _._____________ _________ 11 73.3 4 26.7 15 100.0 Total5 ____________________________ 641 90.9 64 9.1 705 100.0 Prior nursing preparation Hospital diploma___.___ _________ 223 91.4 21 8.6 244 100.0 Associate degree_._ __________________ __ 33 82.5 7 17.5 40 100.0 Baccalaureate degree __________ _ 353 90.1 39 9.9 392 100.0 Master’s degree _______...__._____ 45 93.8 3 6.2 48 100.0 Total__.______-_ _____________ 654 90.3 70 9.7 724 100.0 Employment changes after graduation None ___________-_______ 515 97.0 16 3.0 531 100.0 One or more _______ ________ 129 72.5 49 27.5 178 100.0 Total6 _________________________________ 644 90.8 65 9.2 709 100.0 lThree graduates did not supply information on ANA membership. 2Eight graduates did not supply information on years in professional nursing. 3Sixteen graduates had not been previously employed. ‘ Othe'rincludes settings within State and Federal agencies including the armed services, inservice education, and social agencies, as well as combined inpatient/outpatient settings. 6Three graduates did not supply information on previous employment setting. 6Fifteen graduates did not supply information on employment changes. Table 16.—Employment status of graduates, by number of years in professional nursing and type of NP program Years in professional nursing and type of program None 6—10 11-15 >15 Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Employed as NPl Providing primary care __ 123 73.2 110 76.9 67 80.8 96 81.4 396 77.3 Teaching, consulting, etc.__.—_ 1 .6 6 4.2 2 2.4 3 2.5 12 2.3 Employed, not as NP _.__________ 19 11.3 10 7.0 6 7.2 16 13.6 51 10.0 Not employed 25 14.9 17 11.9 8 9.6 3 2.5 53 10.4 Total 168 100.0 143 100.0 83 100.0 118 100.0 512 100.0 Master’s Employed as NP1 Providing primary we 57 53.3 18 35.3 17 54.8 5 33.3 97 47.6 Teaching, consulting, etc. 12 11.2 5 9.8 3 9.7 20 9.8 Employed, not as NP __________ 33 30.8 18 35.3 10 32.3 10 66.7 71 34.8 Not employed 5 4.7 10 19.6 1 3.2 16 7.8 Total 107 100.0 51 100.0 31 100.0 15 100.0 204 100.0 Total2 Employed as NPl Providing primary care___________ 180 65.5 128 66.0 84 73.7 101 75.9 493 68.9 Teaching, consulting, etc..___.____ 13 4.7 11 5.7 5 4.4 3 2.3 32 4.5 Employed, not as NP _________ _________ 52 18.9 28 14.4 16 14.0 26 19.5 122 17.0 Not employed 30 10.9 27 13.9 9 7.9 3 2.3 69 9.6 Total 275 100.0 194 100.0 114 100.0 133 100.0 716 100.0 1Included in this category are respondents functioning wholly or in part as NPs. 2Eight graduates of certificate programs did not supply information on years in professional musing. 11 asvna mass {717 Table l7.—-Employment status of graduates, by prior nursing preparation and type of NP program Prior nursing preparation and type of program Hospital Associate Baccalaureate Master’s diploma degree degree degree Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Employed as NPl Providing primary care...________ 198 84.6 29 76.3 152 74.1 24 55.8 403 77.5 Teaching, consulting, etc. ______________-___ 2 0.9 2 5.3 3 1.5 5 11.6 12 2.3 Employed, not as NP____._______________,__ 15 6.4 1 2.6 24 11.7 11 25.6 51 9.8 Not employed 19 8.1 6 15.8 26 12.7 3 7.0 54 10.4 Total 234 100.0 38 100.0 205 100.0 43 100.0 520 100.0 Master's Employed as NPl Providing primary care____.____ 3 30.0 1 50.0 90 48.1 3 60.0 97 47.6 Teaching, consulting, etc. __ _________ _ 1 10.0 17 9.1 2 40.0 20 9.8 Employed, not as NP___..________ 4 40.0 67 35.8 71 34.8 Not employed 2 20.0 1 50.0 13 7.0 16 7.8 Total 10 100.0 2 100.0 187 100.0 5 100.0 204 100.0 Total Employed as NPl Providing primary care__.._______ 201 82.4 30 75.0 242 61.8 27 56.3 500 69.0 Teaching, consulting, etc. _-__________________ 3 1.2 2 5.0 20 5.1 7 14.6 32 4.4 Employed, not as NP _________— 19 7.8 1 2.5 91 23.2 11 22.9 122 16.9 Not employed 2] 8.6 7 17.5 39 9.9 3 6.2 70 9.7 Total 244 100.0 40 100.0 392 100.0 48 100.0 724 100.0 ‘Included in this category are respondents functioning wholly or in part as NPs. SEI'IflVL 917 Table 18.—Employment status of graduates, by class size and type of NP program Class size and type of program <8 8—13 14-17 >17 Total Employment Avg. status No. Pct. N o. Pct. No. Pct. No. Pct. N o. Pct. size Certificate Employed as NPl Providing primary care ____..-_.__ 59 74.7 164 82.0 88 71.0 92 78.7 403 77.5 15.0 Teaching, consulting, etc. _— 1 1.3 4 2.0 2 1.6 5 4.3 12 2.3 15.9 Employed, not as NP..____________-___-____- 6 7.6 14 7.0 21 16.9 10 8.5 51 59.8 14.8 Not employed ._____ ________ 13 16.4 18 9.0 13 10.5 10 8.5 54 10.4 13.1 Total 79 100.0 200 100.0 124 100.0 117 100.0 520 100.0 14.8 Master’s Employed as NP1 Providing primary care __.-__- 38 55.1 36 45.5 11 32.4 12 54.6 97 47.6 11.5 Teaching, consulting, etc. -__.___ 2 2.9 12 15.2 3 8.8 3 13.6 20 9.8 12.4 Employed, not as NP___________ ______ 22 31.9 24 30.4 19 55.9 6 27.3 71 34.8 11.1 Not employed —______.-___ 7 10.1 7 8.9 1 2.9 1 4.5 16 7.8 9.2 Total _____________—_ 69 100.0 79 100.0 34 100.0 22 100.0 204 100.0 11.3 Total Employed as NPl Providing primary care _____ 97 65.6 200 71.7 99 62.6 104 74.8 500 69.1 14.3 Teaching, consulting, etc. ______.____ 3 2.0 16 5.7 5 3.2 8 5.8 32 4.4 13.7 Employed, not as NP____..___ ______ 28 18.9 38 13.6 40 25.3 16 11.5 122 16.8 12.7 Not employed _— _____ 20 13.5 25 9.0 14 8.9 11 7.9 70 9.7 12.2 Total 148 100.0 279 100.0 158 100.0 139 100.0 724 100.0 13.8 ‘ Included in this category are respondents functioning wholly or in part as NPS. 11 asvnd AtlfLLS 917 TABLES 47 Table 19.—Employment status of graduates, by response of their program directors to the question: “Does demand for graduates exceed supply?” and type of NP program Response to question: “Does demand exceed supply?” and type of program Yes No Don’t know Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. Certificate Employed as NPl Providing primary care ___ 273 77.7 58 71.6 68 81.0 399 77.3 Teaching, consulting, etc. _________ 9 2.6 2 2.5 1 1.2 12 2.3 Employed, not as NP _________________ 40 11.4 4 4.9 7 8 3 51 9.9 Not employed ________________ __ 29 8.3 17 21.0 8 9.5 54 10.5 Total _________________ 351 100.0 81 100.0 84 100.0 516 100.0 Master’s Employed as NPl Providing primary care __________ 86 52.1 5 21.7 6 37.5 97 47.6 Teaching, consulting, etc. ________ 18 10.9 2 8.7 20 9.8 Employed, not as NP_______ 46 27.9 15 65.3 10 62.5 71 34.8 Not employed_______ _______ 15 9.1 1 43 16 7.8 Total _____ ____________ __ 165 100.0 23 100.0 16 100.0 204 100.0 Total2 Employed as NP1 . Providing primary care ________ 359 69.6 63 60.6 74 74.0 496 69.0 Teaching, consulting, etc. _____ _ 27 5.2 4 3.8 1 1.0 32 4.4 Employed, not as NP__ ______________ 86 16.7 19 18.3 17 17.0 122 16.9 Not employed ____________________ _ 44 8.5 18 17.3 8 8 0 70 9.7 Total________.____. 516 100.0 104 100.0 100 100.0 720 100.0 1Included in this category are respondents functioning wholly or in part as NPs. 2A certificate program accounting for four graduates did not respond to the question. Table 20.—Employment status of graduates, by length and type of NP program Length (in months) and type of program 3—5 6—8 9—11 12—17 >18 Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Avg. Certificate Employed as NP1 Providing primary care __ 118 75.2 80 75.5 73 72.3 106 83.4 26 89.8 403 77.5 8.9 Teaching, consulting, etc. 3 1.9 1 0.9 4 4.0 3 2.4 1 3.4 12 2.3 9.5 Employed, not as NP— 17 10.8 11 10.4 15 14.8 7 5.5 1 3.4 51 9.8 7.9 Not employed ____________________ 19 12.1 14 13.2 9 8.9 11 8.7 1 3.4 54 10.4 7.6 Total 157 100.0 106 100.0 101 100.0 127 100.0 29 100.0 520 100.0 8.7 Master’s Employed as NPl Providing primary care — — -- — 7 77.8 49 40.5 41 55.4 97 47.6 15.5 Teaching, consulting, etc. --___ — — — — 2 22.2 13 10.7 5 6.8 20 9.8 14.4 Employed, not as NP_.____ _____________ — — —- — 49 40.5 22 29.7 71 34.8 14.6 Not employed _ -- - — — 10 8.3 6 8.1 16 7.8 15.0 Total — — — — 9 100.0 121 100.0 74 100.0 204 100.0 15.0 Total Employed as NP1 Providing primary care .___________ 118 75.2 80 75.5 80 72.7 155 62.5 67 65.1 500 69.1 10.1 Teaching, consulting, etc. 3 1.9 1 0.9 6 5.5 16 6.4 6 5.8 32 4.4 12.6 Employed, not as NP.______ 17 10.8 11 10.4 15 13.6 56 22.6 23 22.3 122 16.8 11.8 Not employed __________ 19 12.1 14 13.2 _ 9 8.2 21 8.5 7 6.8 70 9.7 9.3 Total __.________ ________ _ 157 100.0 106 100.0 110 100.0 248 100.0 103 100.0 724 100.0 10.4 1Included in this category are respondents functioning wholly or in part as NPs. 11 ssvnd AGILLS 817 Table 21.—Employment status of graduates, by length of didactic component and type of NP program Length of didactic components1 (in months) and type of program 4—6 7—12 13—21 Total Employment status No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Avg. Certificate Employed as NP2 Providing primary care 110 80.9 248 76.9 45 73.8 -- — 403 77.5 4.6 Teaching, consulting, etc. _—_ 4 2.9 5 1.5 3 4.9 — — 12 2.3 4.7 Employed, not as NP 10 7.4 34 10.5 7 11.5 —- -- 51 9.8 4.8 Not employed 12 8.8 36 11.1 6 9.8 -- — 54 10.4 4.7 Total 136 100.0 323 100.0 61 100.0 — — 520 100.0 4.6 Master‘s Employed as NP2 Providing primary care -— — 34 40.5 63 54.8 97 47.6 15.0 Teaching, consulting, ebc.___ — — 1 20.0 10 11.9 9 7.8 20 9.8 13.7 Employed, not as NP — — 3 60.0 33 39.3 35 30.4 71 34.8 14.1 Not employed -— - 1 20.0 7 8.3 8 7.0 16 7.8 13.7 Total — — 5 100.0 84 100.0 115 100.0 204 100.0 14.5 Total Employed as NP2 Providing primary care 110 80.9 248 75.6 79 54.4 63 54.8 500 69.1 6.6 Teaching, consulting, etc. ___.____..___________.-_ 4 2.9 6 1.8 13 9.0 9 7.8 32 4.4 10.3 Employed, not as NP 10 7.4 37 11.3 40 27.6 35 30.4 122 16.8 12.9 Not employed 12 8.8 37 11.3 13 9.0 8 7.0 70 9.7 6.8 Total 136 100.0 328 100.0 145 100.0 115 100.0 724 100.0 7.8 1 The didactic portion includes a classroom and a clinical component. The classroom includes such activities as lectures and self-instruction. The clinical component includes relevant clinical observations and experiences and operates concurrently with the classroom component. 2Included in this category are respondents functioning wholly or in part as NPs. 6f; STIHVJ. 50 STUDY PHASE II Table 22.—Employment status of graduates, by whether or not the NP program required a preceptorship and type of NP program Preceptorshipl requirement and type of program Not required Required Total Employment No. Pct. No. Pct. No. Pct. Certificate Employed as N P2 Providing primary care_ _______________ 116 67.9 287 82.3 403 77.5 Teaching, consulting, etc._________.____ 5 2.9 7 2.0 12 2.3 Employed, not as NP__________ 25 14.6 26 7.4 51 9.8 Not employed _________________________ 25 14.6 29 8.3 54 10.4 TotaL____ _______________ 171 100.0 349 100.0 520 100.0 Master’s Employed as NP2 Providing primary care__ ______________ 80 47.0 17 50.0 97 47.6 Teaching, consulting, etc.- _ 16 9.4 4 11.8 20 9.8 Employed, not as NP _____________ _ 63 37.1 8 23.5 71 34.8 Not employed_ __________________________ 11 6.5 5 14.7 16 7.8 Total_—___________ 170 100.0 34 100.0 204 100.0 Total Employed as NP2 Providing primary care_________ 196 57.4 304 79.3 500 69.1 Teaching, consulting, etc _____ 21 6.2 11 2.9 32 4.4 Employed, not as NP ________________ _ 88 25.8 34 8.9 122 16.8 Not employed __ ________ __ 36 10.6 34 8.9 70 9.7 TotaL...___.______________ 341 100.0 383 100.0 724 100.0 1The internship or preceptorship portion is a specified period of supervised clinical practice in patient assessment and management and is a requirement for completion of some programs. This is distinct from and follows the clinical experience ofiered concurrently with the didactic portion. There were 31 certificate and 33 master‘s programs which did not include a preceptorship. 2Included in this category are respondents functioning wholly or in part as NPs. TABLES 51 Table 23.—Employed graduates, by length of employment after graduation to the date of the survey and type of NP program Type of program Length of Certificate Master’s Total1 employment (in months) No. Pct. No. Pct. No. Pct. <7 20 4.6 17 9.4 37 6.0 7—12 94 21.8 28 15.6 122 20.0 13—18 179 41.6 77 42.8 256 41.9 19—24 131 30.4 57 31.7 188 30.8 >24 7 1.6 1 .5 8 1.3 Total 431 100.0 180 100.0 611 100.0 Median 16 15 15 lThirty-five employed graduates of certificate programs and eight employed graduates of master’s programs did not supply information on the length of employment. Table 24.—Graduates, by employment changes after graduation and type of NP program Type of program Certificate Master’s Total 1 Employment changes after graduation No. Pct. No. Pct. No. Pct. None 376 75.8 139 70.5 515 74.3 1 96 19.4 49 24.9 145 20.9 >2 13 2.6 7 3.6 20 2.9 No. unspecified_____________ 11 2.2 2 1.0 13 1.9 Total_____ _______ 496 100.0 197 100.0 693 100.0 “Thirteen graduates of certificate programs and three graduates of master‘s programs had not been employed after graduation. Eleven graduates of certificate programs and four graduates of master's programs did not supply information on employment changes. 52 STUDY PHASE II Table 25.—Graduates who reported employment changes, by reasons, employment status, and type of NP program Employment status and type of program Not Employed employed Total2 Reasons for employment changes1 No. Pct. No. Pct. No. Pct. Certificate N=83 N =37 N 120 Lack of opportunity to use new skills __ 36 43.4 11 29.7 47 39.2 Better job opportunity ______.______________ 45 54.2 1 2.7 46 38.3 Family responsibilities ___—___..- 19 22.9 20 54.1 39 32.5 Not enough role autonomy__________ 13 15.7 3 8.1 16 13.3 Salary not commensurate with responsibility ___ 13 15.7 2 5.4 15 125 Work load too light ___..__. _________ 8 9.6 3 8.1 11 9.2 Incompatability with physician ___..._____ 7 8.4 2 5.4 9 7.5 Work load too heavy ________________ 4 4.8 1 2.7 5 4.2 Lack of medical backup ________________- 8 9.6 1 2.7 9 7.5 Incompatability with other nursing staff. __ 6 7.2 1 2.7 7 5.8 To continue education 2 2.4 4 10.8 6 5.0 Master’s N=46 N=12 N 58 Lack of opportunity to use new skills 28 60.9 4 33.3 32 55.2 Better job opportunity __ ___________ __ 21 45.7 1 8.3 B 37.9 Family responsibilities ___—___“ 7 15.2 6 50.0 13 22.4 Not enough role autonomy __ 13 28.3 13 22.4 Salary not commensurate with responsibility __ 10 21.7 2 16.7 12 20.7 Work load too light_._____-__-____ _____ __ 5 10.9 5 8.6 Incompatability with physician ___-___ 6 13.0 6 10.3 Work load too heavy__ 6 13.0 1 8.3 7 12.1 Lack of medical backup _____ _____ 3 6.5 3 5.2 Incompatability with other nursing staff ___ 4 8.7 4 6.9 To continue education - ‘Categories are not mutually exclusive. 2Eleven graduates of certificate programs and four graduates of master’s programs did not supply information on employment changes. TABLES 53 Table 26.—Employed graduates, by intervening months between graduation and initial employment and type of NP program Type of program Certificate Master’s Total 1 Intervening months No. Pct. No. Pct. No. Pct. <1 264 61.5 49 27.5 313 51.6 1 71 16.6 68 38.2 139 22.9 2—3 57 13.3 37 20.8 94 15.5 4—6 18 4.2 19 10.7 37 6. 1 7—12 15 3.5 2 1.1 17 2.8 >12 4 .9 3 1. 7 7 1.1 Total 429 100.0 178 100.0 607 100.0 l’I‘hirty»seven employed graduates of certificate programs and 10 employed graduates of master‘s programs did not supply information on intervening months between graduation and initial employment. Table 27.—-Employed graduates,‘ by whether the current employment setting was the same as that prior to NP preparation and type of NP program Type of program Certificate Master’s Total2 Employment setting No. Pct. No. Pct. N o. Pct. Same 216 48.2 25 14.0 241 38.4 Not the same __________ 232 51.8 154 86.0 386 61.6 Total 448 100.0 179 100.0 627 100.0 lThis presentation is based on graduates who were employed both before and after NP preparation. Ten employed graduates were not employed prior to NP preparation. 2Nine employed graduates of certificate programs and eight employed graduates of master’s programs did not supply information on whether the present employment setting was the same as that prior to NP preparation. 54 STUDY PHASE II Table 28.—Employed graduates,‘ by intervening months between graduation and first employment, whether the current employment setting was the same as that before NP preparation, and type of NP program Employment setting and type of program Same Not the same Total Intervening months No. Pct. No. Pct. N0. Pct. Certificate <1 147 74.3 113 51.8 260 62.5 1 28 14.1 39 17.9 67 16.1 2—3 19 9.6 34 15.6 53 12.7 4—6 2 1.0 15 6.9 17 4.1 7—12 2 1.0 13 6.0 15 3. 6 > 12 -- — 4 1.8 4 1.0 Total 198 100.0 218 100.0 416 100.0 Master’s <1 8 34.8 39 26.4 47 27.5 1 8 34.8 59 39.8 67 39. 1 2-3 3 13.0 31 20.9 34 19.9 4—6 3 13.0 16 10.8 19 11.1 7—12 -- -- 1 0.7 1 0.6 >12 1 4.4 2 1.4 3 1.8 Total 23 100.0 148 100.0 171' 100.0 Total2 <1 155 70.1 152 41.5 307 52.4 1 36 16.3 98 26.8 134 22.8 2—3 m 10.0 65 17.8 87 14.8 4—6 5 2.3 31 8.5 36 6. 1 7—12 2 0.9 14 3.8 16 2.7 >12 1 0.4 6 1. 6 7 1.2 Total 221 100.0 366 100.0 587 100.0 1This presentation is based on graduates who were employed both before and after NP preparation. Ten employed graduates were not employed prior to NP preparation. 2Forty—one employed graduates of certificate programs and 16 employed graduates of master's programs did not supply information on intervening months, whether the present employment setting was the same as that prior to NP preparation, or both. TABLES 55 Table 29.—-Graduates who were not employed, by reasons and type of NP program Type of program Certificate Master’s Total2 N=50 N= 13 N = Reasons not employed1 No. Pct. No. Pct. No. Pct. Nursing leadership at the place of em- ployment is not familiar with, or not accepting of, the role_____ _____ 4 8.0 4 6.3 Not seeking employment ________________ 18 36.0 6 46.2 24 38.1 Physicians are accepting of the role, but there are no jobs available _ 11 22.0 1 7.7 12 19.0 Physicians approached are not familiar with, or not accepting of, the role____ 5 10.0 1 7.7 6 9.5 No job classification exists for this role at the place of employment___.___. 6 12.0 6 9.5 Attending another NP program _________ 1 2.0 1 1.6 Other3 __ __________________________ 18 36.0 5 38.5 23 36.5 lCategories are not mutually exclusive. 2Four graduates of certificate programs and three graduates of master’s programs did not supply information on reasons they were not employed. 3Other reasons they were not employed were primarily personal or to continue their educations. Table 30.—Employed graduates not functioning as NPs, by selected employment settings and type of NP program Type of program Certificate Master’s Total N =51 N=71 N = 122 Employment setting1 No. Pct. No. Pct. No. Pct. Inhospital practice _.___________._.-____ 16 31.4 30 42.3 46 37.7 Ambulatory practice ________________________ 10 19.6 6 8.4 16 13.1 Nonhospital institutional setting___ 14 27.4 1 1.4 15 12.3 N onhospital community setting ________ 8 15.7 3 4.2 11 7.0 School of nursing ____ __________________ 13 25.5 47 66.2 60 49.2 Extended care facility _________._ ________ 5 9.8 5 4.1 Other setting2 __-_____.________,____ 4 7.8 2 2.8 6 4.9 lCategories are not mutually exclusive. 2Oflm‘includes the State chapter of a national foundation, 3 State peer review foundation, the American Academy of Pediatrics, the American Nurses’ Association, a pharmaceutical company, and teaching the Lamaze method in an unspecified setting. 56 STUDY PHASE 11 Table 3l.—Average, gross, annual, nursing income of graduates employed full time and part time, by specialty and type of NP program Employment status and type of program Full time (>35 hrs/wk)? Part time (<35 hrs/wk) Total Avg. income Avg. income Avg. income Specialty No. (in dollars) No. (in dollars) No. (in dollars) Certificate Pediatric _-______ 158 13,253 31 10,484 189 12,799 Midwifery-________ 13 14,231 -- — 13 14,231 Maternity __ 23 12,391 9 9,667 32 11,625 Family____. 91 14,110 12 9,917 103 13,621 Adult ___-_______- 86 13,291 15 9,000 101 12,654 Total______ 371 13,453 67 9,940 438 12,916 Master‘s Pediatric _________ 15 13,267 1 14,000 16 13,313 Midwifery—___ 23 14,826 9 9,111 32 13,219 Maternity __ 13 13,923 1 10,000 14 13,643 Family ___- 53 14, 189 3 10,000 56 13,964 Adult __ _____ 40 15,125 2 13,000 42 15,024 Psychiatric _ 15 15,267 2 6,000 17 14,177 TotaL_.____ 159 14,509 18 9,667 177 14,017 Total1 Pediatric ___- 173 13,254 32 10,594 205 12,839 Midwifery_____ 36 14,611 9 9,111 45 13,511 Maternity _____ 36 12,944 10 9,700 46 12,239 Family __.___ 144 14, 139 15 9,933 159 13,742 Adult -_.__.___ 126 13,873 17 9,471 143 13,350 Psychiatric—___ 15 15,267 2 6,000 17 14,177 Total__ ___ 530 13,770 85 9,882 615 13,233 "I‘wo employed graduates of certificate programs worked voluntarily without compensation. Nenty-six employed graduates of certificate program and 11 employed graduates of master‘s prop-ms did not supply information on income, whether they were employed full time or part time, or both. TABLES 57 Table 32.—Graduates employed full time and part time, by gross, annual, nursing income and type of NP program Employment status and type of program Full time Part time Income (>35 hrs/wk)(<35 hrs/wk) Total (in thousands of dollars) No. Pct. No. Pct. No. Pct. Certificate <6 12 17.9 12 2.7 6—10 49 13.2 27 40.3 76 17.4 11—15 250 67.4 23 34.3 273 62.3 16—20 65 17.5 4 6.0 69 15.8 >20 7 1.9 1 1.5 8 1.8 Total 371 100.0 67 100.0 438 100.0 Master’s <6 4 E2 4 2.3 6-10 4 2.5 7 38.9 11 6.2 11—15 106 66.6 6 33.3 112 63.3 16-20 47 29.6 1 5.6 48 27.1 >20 2 1.3 2 1.1 Total 159 100.0 18 100.0 177 100.0 Total1 <6 16 18.8 16 2.6 6—10 53 10.0 34 40.0 87 14.2 11—15 356 67.2 29 34.1 385 62.6 16—20 112 21.1 5 5.9 117 19.0 >20 9 1.7 1 1.2 10 1.6 Total 530 100.0 85 100.0 615 100.0 l'l‘wo employed graduates of certificate programs worked voluntarily without compensation. Twenty-six employed graduates of certificate programs and 11 employed yaduntes of master’s program did not supply information on income, whether they were employed full time or part time, or both. Table 33.—Graduates employed full time, by gross, annual, nursing income, specialty, and type of NP program Specialty and type of program Income Pediatric Midwifery Maternity Family Adult Psychiatric Total (in thousands of dollars) No. Pct. N0. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate 6—10_ __._. __________ _ 26 16.5 7 30.5 3 3.3 13 15.1 — — 49 13.2 11—15_____—____ 99 62.6 9 69.2 14 60.9 68 74.7 60 69.7 -— — 250 67.4 l6—20___.—_____._________ 30 19.0 4 30.8 1 4.3 18 19.8 12 14.0 -- -- 65 17.5 >20 __________ 3 1.9 1 4.3 2 2.2 l 1.2 —- —- 7 1.9 Total _.____________________ 158 100.0 13 100.0 23 100.0 91 100.0 86 100.0 — -- 371 100.0 Master’s 6—10 —___ 1 6.7 2 15.4 1 1.9 4 2.5 11—15_____.____._____ 13 86.6 16 69.6 7 53.8 37 69.8 23 57.5 10 66.6 106 66.7 16—20___________ ______ _..___ 1 6.7 7 30.4 4 30.8 15 28.3 16 40.0 4 26.7 47 29.6 >20 ________ 1 2.5 1 6.7 2 1.2 Total _________-______._. 15 100.0 23 100.0 13 100.0 53 100.0 40 100.0 15 100.0 159 100.0 Total1 6—10_______________._ 27 15.6 . . . . . . 9 25.0 4 2.8 13 10.3 . . . . . . 53 10.0 11—15_________________ 112 64.8 25 69.4 21 58.3 105 72.9 83 63.9 10 66.6 356 67.2 16—20 __ _________ 31 17.9 11 30.6 5 13.9 33 22.9 28 22.2 4 26.7 112 21.1 >20___—_ 3 1.7 1 2.8 2 1.4 2 1.6 1 6.7 9 1.7 Total __.______— 173 100.0 36 100.0 36 100.0 144 100.0 126 100.0 15 100.0 530 100.0 1’l‘wo employed graduates of certificate programs worked voluntarily without compensation. Thirteen employed graduates of certificate programs and six employed graduates of master’s programs did not supply information on income. II HSVHd AGILLS 89 Table 34.—Average, gross, annual, nursing income of graduates employed full time, by employment status, specialty, and type of NP program Spedalty and type of program Pediatric Midwifery Maternity Family Adult Psychiatric Total No. Avg. income No. Avg. income No. Avg. income No. Avg. income No. Avg. income No. Avg. income No. Avg. income Employment status (in dollars) (in dollars) (in dollars) (in dollars) (in dollars) (in dollars) (in dollars) Oertifimte Employed as NP1 Providing primary care ________ 138 13,123 9 14,111 17 12,647 89 14,101 80 13,38 —- — 333 13,426 Teaching, consulting, etc. 3 17,000 2 15,500 —« -— 2 14,000 —— —- 7 15,714 Employed, not as NP 17 13,647 2 13,500 6 11,667 2 14,500 4 13,000 — —- 31 13,226 Total 158 13,253 13 14,231 23 12,391 91 14,110 86 13,291 ~ - 371 13,453 Master’s Employed as NP‘ Providing primary care 6 14,167 16 14,750 4 14,750 41 14,415 14 16,357 3 13,333 84 14,762 Teaching, consulting, etc. 3 13,333 3 16,000 — 6 13,833 2 19,000 3 14,333 17 14,823 Employed, not as NP 6 12,333 4 14,250 9 13,556 6 13,000 24 14,083 9 141m 58 14,062 Total 15 13,267 23 14,826 13 13,923 53 14,189 40 15,125 15 15,267 159 14,509 Total2 Employed as NPl Providing primary care 144 13,167 25 14,520 21 13,048 130 14,200 94 13,745 3 13,333 417 13,695 Teaching, consulting, etc. 6 15,167 5 15,800 —— 6 13,833 4 16,500 3 14,333 24 15,083 Employed, not as NP ____._ 23 13,3)4 6 14,000 15 12,80) 8 13,375 3 13,928 9 16,23 13,764 Total 173 13,254 36 14,611 36 12,944 144 14,139 1% 13,873 15 15,267 530 13,770 1Included in this category are respondents functioning wholly or in part as NPs. 2Two employed graduates of certificate programs worked voluntarily without compensation. Thirteen employed graduates of certificate programs and six employed graduates of master's programs did not supply information on income. 69 smava Table 35.-—Average, gross, annual, nursing income of graduates employed full time and part time, by region and type of NP program Region1 and type of program West Midwest Northeast South Total Employment Avg. income Avg. income Avg. income Avg. income Avg. income status No. (in dollars) No. (in dollars) No. (in dollars) No. (in dollars) No. (in dollars) Certificate Full time (>35 hrs/wk)___ 106 14,170 71 13,056 90 13,667 104 12,808 371 13,453 Part time (<35 hrs/wk) __— 17 9,412 14 10,786 27 10,630 9 7,556 67 9,940 Total _____ 123 13,512 85 12,682 117 12,966 113 12,389 438 12,916 Master’s Full time (>35 hrs/wk) 30 14,500 28 15,214 49 14,041 50 14,400 157 14,452 Part time (<35 hrs/wk) 6 11,167 4 5,750 4 9,500 3 11,333 17 9,529 Total 36 13,944 32 14,031 53 13,698 53 14,226 174 13,971 Total2 Full time (>35 hrs/wk) __ 136 14,243 99 13,667 139 13,799 154 13,325 528 13,750 Part time (<35 hrs/wk) h 23 9,870 18 9,667 31 10,484 12 8,500 84 9,857 Total _____________ 159 13,610 117 13,051 170 13,194 166 12,976 612 13,216 1Regions are those designated by the National League for Nursing (see figure 1) and refer to the location of the graduates when they completed questionnaires in phase 2. 2Two employed graduates of certificate programs worked voluntarily without compensation. Nenty-six employed graduates of certificate programs and 14 employed graduates of master‘s programs were located in foreign countries or did not supply information on income or on whether they were employed full time or part time, or combinations of the three variables. 11 EISVHd AGILLS 09 Table 36.—Graduates employed full time, by gross, annual, nursing income, region, and type of NP program Region1 and type of program Income West Midwest Northeast South Total (in thousands of dollars) No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate 6—10 6 5.7 10 x 14. 1 14 15.6 19 18.3 49 13.2 11—15 72 67.9 50 70.4 54 60.0 74 71. 1 250 67.4 16—20 25 23.6 10 14.1 22 24.4 8 7.7 65 17.5 >20 3 2.8 1 1.4 3 2.9 7 1.9 Total 106 100.0 71 100.0 90 100.0 104 100.0 371 100.0 Master’s 6—10 1 3.6 2 4.1 1 2.0 4 2.5 11—15 21 70.0 12 42.8 36 73.5 37 74.0 106 67.5 16—20 8 26.7 15 53.6 11 22.4 11 22.0 45 28.7 >20 1 3.3 1 2.0 2 1.3 Total 30 100.0 28 100.0 49 100.0 50 100.0 157 100.0 Total2 6—10 6 4.4 11 11.1 16 11.5 20 13.0 53 10.0 11—15 93 68.4 62 62.6 90 64.8 111 72. 1 356 67.5 16—20 33 24.3 25 25.3 33 23.7 19 12.3 110 20.8 >20 4 2.9 1 1.0 4 2.6 9 1.7 Total 136 100.0 99 100.0 139 100.0 154 100.0 528 100.0 1Regions are thou designated by the National League for Nursing (see figure 1) and refer to the location of the graduates when they completed questionnaires in phase 2. x"I‘wo employed graduates of certificate programs worked voluntarily without compensation. Thirteen employed graduates of certificate programs and eight employed paduates of master's programs did not supply information on income, were located in foreign countries, or both. SEI'IHVL I9 62 STUDY PHASE II Table 37.—Average, gross, annual, nursing income of graduates working as NPs, by employment status, practice setting location, and type of NP program Employment status and type of program Full time Part time (>35 hrs/wk) (<35 hrs/wk) Total Practice setting Avg. income Avg. income Avg. income location No. (in dollars) No. (in dollars) No. (in dollars) Certificate Inner city__-____----______-________- 103 13,660 20 11,150 123 13,252 Other urban _______________________ 50 13,300 12 8,833 62 12,435 Suburban _____ 26 15,577 7 6,857 33 13,727 Rural ____________________________ 69 12,507 8 7,625 77 12,000 Combination‘____--__-____________- 15 14,733 3 12,333 18 14,333 Other2 _____________________________ 75 13,280 6 12,500 81 13,222 13,482 56 9,821 394 12,962 Master’s Inner city----_______-_______--______ 39 15,000 4 10,000 43 14,535 Other urban __-_ 15,080 4 7,250 29 14,000 Suburban _____ 14,889 2 12,000 11 14,364 Rural _ ____________________________ 8 14,250 --- --- 8 14,250 14,000 1 7,000 4 12,250 14,267 2 11,000 17 13,882 14,606 13 9,385 112 14,179 Total3 14,028 24 10,958 166 13,584 Other urban ____________ 13,893 16 8,438 91 12,934 Suburban ________________ 15,400 9 8,000 44 13,886 Rural ______________________________ 77 12,688 8 7,625 85 12,212 Combination‘ ______________________ 18 14,611 4 11,000 22 13,955 Other2 _______ ___ 90 13,444 8 12,125 98 13,337 Total _______--.______-_-_______-__ 437 13,783 69 9,739 506 13,231 ‘Combination includes two or more of the selected practice setting locations. 20th” includes military installations, VA hospitals, industry, college/university campuses, Indian reservations, religious communities, and construction sites. aTwo NPs completing certifimte programs worked voluntarily without compensation. Nineteen NPs completing certificate programs and five NPs completing master’s programs did not supply information on gross, annual, nursing income, practice setting location, or both. TABLES 63 Table 38.——Average, gross, annual, nursing income of graduates employed full time1 before and after NP preparation, by type of NP program Type of program Avg. income Certificate Master’s Total (in dollars) N = 293 N = 130 N =423 Before NP preparation ______________________________ 11,096 10,369 10,873 After NP preparation ___________ 13,447 14,500 13,771 Increase 2,351 4,131 2,898 "I‘his presentation is based on graduates employed full time before and after NP preparation. Table 39.—-Graduates employed full time,1 by gross, annual, nursing income before and after NP preparation and type of NP program Type of program Before After Income NP preparation NP preparation (in thousands of dollars) No. Pct. No. Pct. Certificate 6—10 147 50.2 38 13.0 11—15 118 40.3 201 68.6 16—20 27 9.2 49 16.7 >20 1 .3 5 1.7 Total 293 100.0 293 100.0 Master’s 6—10 84 64.6 3 2.3 11—15 44 33.9 88 67.7 16—20 2 1.5 38 29.2 >20 1 .8 Total 130 100.0 130 100.0 Total 6—10 231 54.6 41 9.7 11—15 162 38.3 289 68.3 16—20 29 6.9 87 20.6 >20 1 .2 6 1.4 Total 423 100.0 423 100.0 1This presentation is based on graduates employed full time before and after NP preparation. 64 STUDY PHASE 11 Table 40.—-Graduates employed full time,1 by gross, annual, nursing income before NP preparation, gross, annual, nursing income after NP preparation, and type of NP program Income after NP preparation (in thousands of dollars) and type of program Income before NP preparation 6—10 11—15 16—20 >20 Total (in thousands of dollars) No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate 6—10--___________--__-______ 35 23.8 104 70.7 7 4.8 1 .7 147 100.0 11—15___ 3 2.5 95 80.6 19 16.1 1 .8 118 100.0 16—20 ________________________ 2 7.4 23 85.2 2 7.4 27 100.0 >20 ______________________ 1 100.0 1 100.0 Total _____________________ 38 13.0 201 68.6 49 16.7 5 1.7 293 100.0 Master's 6—10 ________________________ 1 1.2 67 79.7 15 17.9 1 1.2 84 100.0 11—15 ____________________ 2 4.6 21 47.7 21 47.7 44 100.0 2 100.0 2 100.0 Total_-__-_-_________-__-_ 3 2.3 88 67.7 38 29.2 1 .8 130 100.0 Total 6—10 ________________________ 36 15.6 171 74.0 22 .95 2 .9 231 100.0 5 3.1 116 71.6 40 24.7 1 .6 162 100.0 2 6.9 25 86.2 2 6.9 29 100.0 1 100.0 1 100.0 41 9.7 289 68.3 87 20.6 6 1.4 423 100.0 1This presentation is based on graduates employed full time before and after NP preparation. TABLES 65 Table 41.—Average, anticipated and actual increase in income and average, gross, annual, nursing income after NP preparation of graduates employed full time,l by specialty and type of NP program Type of program Average Average anticipated actual Average No. of increase No. of increase income Specialty graduates (in dollars) graduates (in dollars) (in dollars) Certificate Pediatric __________________ 90 778 122 2,074 13,393 Midwifery _____ 9 1,500 11 2,182 14,091 Maternity________-_______ 13 1, 1 15 20 2,600 12, 450 Family_____________--______ 59 2,305 76 2, 960 14, 145 Adult _______________________ 47 915 64 2,109 12,922 Total _____________________ 218 1,271 293 2,351 13,447 Master’s Pediatric ____________,_____ 11 3,182 13 3,308 13,154 Midwifery _______________ 16 3,344 19 4,474 14,790 ‘ 10 3,000 10 3,800 13,700 33 3,424 42 3,667 14,310 31 3,871 36 4,806 15,194 7 4,071 10 4,400 14,800 108 3,519 130 4,131 14,500 Total 101 1,040 135 700 13,370 25 2,680 30 3,634 14,534 23 1,935 30 3,000 12,867 92 2,706 118 3,212 14,204 78 2,090 100 3,080 13,740 7 4,071 10 4,400 14,800 3262 2,015 423 2,898 13,771 1This presentation is based on graduates employed full time before and after NP preparation. 2Seventy-five employed graduates of certificate programs and 22 employed graduates of number‘s programs could not specify their expectations. 66 STUDY PHASE II Table 42.—Average, anticipated, and actual increase in income and average, gross, annual, nursing income after NP preparation of graduates employed full time,1 by employment status and type of NP program Type of program Average Average anticipated actual Average No. of increase No. of increase income Employment status graduates (in dollars) graduates (in dollars) (in dollars) Certificate Employed as NP2 Providing primary care .. _______________ 197 1,383 260 2,419 13,419 Teaching, consulting, etc. ____________________ 5 —500 5 2,200 16,000 Employed, not as NP__ 16 437 28 1,750 13,250 Total _ ________________ 218 1,271 293 2,351 13,447 Master’s Employed as NP2 Providing primary care ___________________ 55 3,664 68 4,117 14,735 Teaching, consulting, etc. _______--_____-____ 11 3,727 13 5,385 15,308 Employed, not as NP_- 42 3,274 49 3,816 13,959 Total __________________ 108 3,519 130 4,131 14,500 Total Employed, as NP2 Providing primary care __________________ 252 1,881 328 2,771 13,692 Teaching, consulting, etc _____________________ 16 2,406 18 4,500 15,500 Employed, not as NP__ 58 2,491 77 3,065 13,701 Total __________________ 3263 2,015 423 2,898 13,771 1This presentation is based on graduates employed full time before and after NP preparation. 2Included in this category are respondents functioning wholly or in part as NPs. aSeventyfive employed graduates of certificate programs and 22 employed graduates of master’s programs could not specify their expectations. TABLES 67 Table 43.—-—Average, anticipated, and actual increase in income and average, gross, annual, nursing income after NP preparation of graduates employed full time,1 by prior nursing preparation and type of NP program Type of program Average Average anticipated actual Average Prior nursing No. of increase No. of increase income preparation graduates (in dollars) graduates (in dollars) (in dollars) Certificate Hospital diploma _____ _ 101 13% 143 2,021 12,699 Associate degree _______ 17 2,647 23 3,174 13,217 Baccalaureate degree __ 83 1, 102 103 2,379 13,874 Master’s degree _.__._ 17 412 24 3,417 16,292 Total _____________ 218 1,271 293 2,351 13,447 Master’s Hospital diploma ____ 5 3,700 5 5,000 14,200 Associate degree __ 1 2,500 1 1,000 14,000 Baccalaureate degree _ 100 3,540 120 4,158 14,517 Master’s degree __ 2 2,500 4 3,000 14,500 Total- __________ 108 3,519 130 4,131 14,500 Total Hospital diploma 106 1,434 148 2,122 12,750 Associate degree ______ 18 2,639 24 3,083 13,250 Baccalaureate degree __ 183 2,434 223 3,336 14,220 Master’s degree ______ 19 632 28 3,357 16,036 Total ___________ 3262 2,015 423 2,898 13,771 1This presentation is based on graduates employed full time before and after N? preparation. 2Seventy-five employed graduates of certificate programs and 22 employed graduates of master's programs, 68 STUDY PHASE II Table 44.—NPs,l by the one employment setting in which they spent most of their time as NPs and type of NP program Type of program Certificate Master’s Total Employment setting No. Pct. No. Pct. No. Pct. Inhospital practice _________________ 22 5.5 13 13.4 35 7.0 Patient unit __ _______________ 17 4.2 12 12.4 29 5.8 Emergency room _______._______ 5 1.3 1 1.0 6 1.2 Ambulatory clinical practice._____ 248 61.5 69 71.2 317 63.4 Private practice_ _________________ __ 59 14.6 12 12.4 71 14.2 Prepaid group practice__ _______ _ 15 3.7 5 5.2 20 4.0 Hospital based clinic_____ 75 18.6 27 27.8 102 20.4 Community based clinic or center _____ 93 23.1 23 23.7 116 23.2 Other ambulatory practice__. _________ 6 1.5 2 2.1 8 1.6 Nonhospital institutional setting____ 80 19.9 1 1.0 81 16.2 School for mentally or physically handicapped _____________-___.______ 4 1.0 4 .8 Grades 1—12, public school system _-__ 32 7.9 32 6.4 College health program_ _______ 43 10.7 1 1.0 44 8.8 Other nonhospital institutional set- ting _.______ ____________ 1 .3 1 .2 Nonhospital community setting 42 10.4 8 8.2 50 10.0 Health department or home health agency _ ____________________ __ 40 9.9 6 6.2 46 9.2 Social services or agency__________ 2 .5 1 1.0 3 .6 Other nonhospital community setting 1 1.0 1 .2 School of nursing ____-_______________ 2 2.1 2 .4 Extended care facility __________________ 4 1.0 3 3.1 7 1.4 Other2 _‘_________ 7 1.7 1 1.0 8 1.6 Overall_______________.____ 403 100.0 97 100.0 500 100.0 'NPs for this presentation are those providing primary care. 2Otlm-includes industry, airport clinics, and faculty" in an Air Force nurse midwifery program. TABLES 69 Table 45.—Average number of hours per week NPsl functioned as NPs in specific employment settings, by type of NP program Type of program Certificate Master’s Total No. of Average No. of Average No. of Average Employment setting” NPs hrs/wk NPs hrs/wk NPs hrs/wk Inhospital practice ..-—___. 74 16.0 41 14.9 115 15.6 Patient unit ________ 59 16.5 36 16.7 95 16.6 Emergency room _____ 20 13.0 12 7.1 32 10.8 Other hospital practice ___ 3 4.3 1 5.0 4 4.5 Ambulatory practice ___-___ 265 81 24.0 346 28.4 Private practice __ 62 29.0 14 28.4 76 28.9 Prepaid group practice ___... 15 38.4 5 35.2 20 37.6 Hospital based clinic _ _ 84 27.5 41 20.1 125 25.0 Community based clinic or center _______ 112 28.6 29 20.6 141 27.0 Other ambulatory practice _ 6 37.0 4 14.0 10 27.8 Nonhospital institutional set- ting- _____________ 93 3 15.3 96 25.5 School for mentally or phys- ‘ ically handicapped ______ 6 21.8 6 21.8 Grades 1—12, public school system.__ ______ 37 21.3 ... ... 37 21.3 College health program ___ 44 33.9 3 14.7 47 32.7 Other nonhospital institu- tional setting __ ________ 2 21.0 1 8.0 3 16.7 Nonhospital community set- ting___ ___- 60 12 25.5 72 21.3 Health department or home health agency __ 57 21.0 9 28.3 66 22.0 Social services or agency __ 3 8.7 1 26.0 4 13.0 ‘ Other nonhospital commu- nity setting ___.__-___ 1 3.0 2 12.5 3 9.3 School of nursing______ 4 4.0 17 10.8 21 9.5 Extended care facility—___ 13 11.5 6 16.7 19 13.2 Other3_____-______________-__ 13 21.7 5 8.2 18 17.9 Overall ___—___— 403 33.5 97 34.9 500 33.7 lNPs for this presentation are those providing primary care. 2Categories are not mutually exclusive. 3 Othe'rincludes industry, school of medicine family practice, airport clinics, and faculty in an Air Force nurse midwifery program. 70 STUDY PHASE II Table 46.—Practice setting location of NPs,1 by type of NP program Type of program Practice Certificate Master’s Total setting location N o. Pct. N o. Pct. No. Pct. Inner city _____--_-____--_-____--_______-____-_-__ 126 31.4 41 42. 4 167 33. 6 Other urban ______________ 65 16. 3 24 24. 7 89 17. 9 Suburban ________________________________________ 35 8.8 11 11.3 46 9. 3 Rural 77 19.3 7 7.2 84 16.9 Combination2 ___________________________________ 16 4.0 3 3.1 19 3.8 Other3 _______ _ 81 20.2 11 11.3 92 18.5 Total 4 _________-_________________ ___________ 400 100.0 97 100.0 497 100.0 lNPs for this presentation are those providing primary care. 2Combination includes two or more of the selected practice setting locations. 3 Other includes military installations, VA hospitals, industry, college/university campuses, Indian reservations, religious communities, and construction sites. ‘Three NPs completing certificate programs did not supply information on practice setting location. Table 47.—Practice setting location of NPs,1 by specialty and type of NP program Specialty and type of program Practice Pediatric Midwifery Maternity Family Adult Psychiatric Total setting location No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Inner city____________________________________ 70 41. 1 3 33.4 8 32. 0 28 27.5 17 18. 1 -- -- 126 31.4 Other urban ________________________________ 28 16.5 2 22.2 10 40.0 14 13.7 11 11.7 —— -- 65 16.3 Suburban ____________________________________ 20 11.8 1 11.1 1 4.0 5 4.9 8 8.5 -- —- 35 8.8 Rural ___________________---_-__-____-_________ 26 15.3 2 22.2 4 16.0 29 28.4 16 17.0 —— -- 77 19.3 Combination2_ 11 6.5 5 4.9 —- -— 16 4.0 Other3 ______-__--_-_-_________________________ 15 8.8 1 1 1. 1 2 8.0 21 20. 6 42 44. 7 -- —— 81 20.2 Total _______________________________________ 170 100. 0 9 100. 0 25 100. 0 102 100. 0 94 100.0 -- —- 400 100.0 Master’s Inner city ____________________________________ 3 42.8 12 48.0 3 75.0 16 36.3 7 50.0 41 42.4 Other urban _______________________________ 1 14.3 6 24.0 1 25.0 12 27.3 4 28.6 . . . ... 24 24. 7 Suburban _________ ___ 1 14.3 3 12.0 5 11.4 2 66.7 11 11.3 Rural ______________ ___ 1 14.3 3 6.8 2 14.3 1 33.3 7 7.2 Combination2_ --_ 2 8.0 1 2.3 3 3.1 Other3 ______________________________________ 1 14.3 2 8.0 7 15.9 1 7.1 11 11.3 Total _______________________________________ 7 100.0 25 100.0 4 100.0 44 100.0 14 100.0 3 100.0 97 100.0 Total‘ Inner city ____________________________________ 73 41.2 15 44. 1 11 37.9 44 30.2 24 22.2 167 33.6 Other urban ___________--___________________ 29 16.4 8 23.5 1 1 37. 9 26 17.8 15 13.9 ... ... 89 17. 9 Suburban ______ 21 11.9 4 11.8 1 3.4 10 6.8 8 7.4 2 66.7 46 9.3 Rural _---__ _ 27 15.3 2 5.9 4 13.9 32 21.9 18 16.7 1 33.3 84 16.9 Combination2 _______________________________ 11 6.2 2 5.9 6 4.1 19 3.8 SEI'IEIVJ. IL Table 47.—Practice setting location of NPs,1 by specialty and type of NP program—continued Specialty and type of program Practice Pediatric Midwifery Maternity Family Adult Psychiatric Total setting location No. Pct. No. Pc t. N o. Pct. N o. Pct. No. Pct. No. Pct. No. Pct. Other3-_____ ______________________ 16 9.0 3 8.8 2 6.9 28 19.2 43 39.8 92 18.5 Total_____ 177 100.0 34 100.0 29 100.0 146 100.0 108 100.0 3 100.0 497 100.0 1NPs for this presentation are those providing primary care. 2Combination includes two or more of the selected practice setting locations. 3Other includes military installations, VA hospitals, industry, college/university campuses, Indian reservations, religious communities, and construction sites "l'hree NPs completing certificate programs did not supply information on practice setting location. 11 EISVHd AGILLS 8L Table 48.—Practice setting location of NPs,1 by region2 and type of NP program Practice setting location and type of program Inner city Other urban Suburban Rural Combination3 Other4 Total Region No. Pct. No. Pct. No. Pct. No. Pct. Pct. No. Pct. No. Pct. Certificate 28 23.7 21 17.8 16 13.6 24 20.3 6 5.1 23 19.5 118 100.0 25 34.3 12 16.4 7 9.6 13 17.8 3 4.1 13 17.8 73 100.0 42 40.0 18 17.1 2 1.9 17 16.2 3 2.9 23 21.9 105 100.0 31 30.1 14 13.6 10 9.7 23 22.3 4 3.9 21 20.4 103 100.0 Total ____________________________________ 126 31.5 65 16.3 35 8.8 77 19.3 16 4.0 80 20.1 399 100.0 Master’s West ____--___-___ ______________________ 6 27.3 6 27.3 4 18.2 2 9.1 4. 5 3 13.6 22 100.0 Midwest ______________________________________ 14 61.0 7 30.4 1 4.3 1 4.3 23 100.0 Northeast ____ 13 43.3 7 23.3 5 16.7 2 6.7 3.3 2 6.7 30 100.0 South ____ ________________________ 8 36.4 4 18.2 1 4.5 2 9.1 1 4.5 6 27.3 22 100.0 Total_ _________________________________ 41 42.4 24 24.7 11 11.3 7 7.2 3 3.1 11 11.3 97 100.0 Total5 West _ _______________________________ 34 24.2 27 19.3 20 14.3 26 18.6 7 5.0 26 18.6 140 100.0 Midwest ______________________________________ 39 40. 7 19 19. 8 8 8. 3 14 14.6 3 3.1 13 13.5 96 100.0 Northeast _______________________________ _ 55 40. 7 25 18.5 7 5.2 19 14.1 4 3.0 25 18.5 135 100.0 South _________________________________________ 39 31.2 18 14.4 11 8.8 25 20.0 5 4. 0 27 21.6 125 100.0 Total ______________________________________ 167 33.8 89 17.9 46 9.3 84 16.9 19 3.8 91 18.3 496 100.0 lNPs for this presentation are those providing primary are. 2Regions are them designated by the National League for Nursing (see figure 1) and refer to the location of the graduates when they completed questionnaires in phase 2. 3Combination includes two or more of the selected practice setting locations. ‘ Olher includes military installations, VA hospitals, industry, college/university campuses, Indian reservations, religious communities, and construction sites. 5One NP completing a certificate program was located in Guam. Three NPs completing certificate programs did not supply information on practice setting location. 81, sa’xavt Table 49.—Practice setting location of NPs,‘ by employment setting in which NPs spent most of their time functioning as NPs and type of NP program Employment setting and type of program Nonhospital Nonhospital Extended Inhospital Ambulatory institutional community School of care Practice practice practice setting setting nursing facility Other2 Total setting location No. Pct. No. Pct. N o. Pct. N o. Pct. N o. Pct. No. Pct. No. Pct. No. Pct. Certificate Inner city ___ 7 33.3 87 35.3 17 21.2 15 35.7 -- -- 126 31.5 Other urban_______ 7 33.3 45 18.3 6 7.5 5 11.9 -- -- 2 50.0 65 16.3 Suburban _________ _ 2 9.5 24 9.8 4 5.0 5 11 .9 -- --' . . . 35 8.8 Rural ___—____ 4 19. 1 57 23.2 5 6.3 10 23.8 -- —- 1 25.0 77 19.2 Combination3___ 7 2.8 3 3.8 6 14.3 — -- 16 4.0 Other4 ___. 1 4.8 26 10.6 45 56.2 1 2.4 -- — 1 25.0 7 100.0 81 20.2 Total_ ____________ 21 100.0 246 100.0 80 100.0 42 100.0 -- -- 4 100.0 7 100.0 400 100.0 Master’s Inner city _ 8 61.5 29 42.1 3 37.5 1 50.0 41 42.4 Other urban ______ 4 30.8 17 24.7 1 12.5 1 50.0 1 33.4 24 24.7 Suburban. _ 1 7.7 9 13.0 1 33.3 11 11.3 Rural__._____. 5 7.2 2 25.0 7 7.2 Combination3 ______ 1 1.4 2 25.0 3 3.1 Other4 ______ 8 11.6 1 100.0 1 33.3 1 100.0 11 11.3 TotaL 13 100.0 69 100.0 1 100.0 8 100.0 2 100.0 3 100.0 1 100.0 97 100.0 Total6 Inner city ____ 15 44.1 116 36.8 17 21.0 18 36.0 1 50.0 167 33.6 Other urban_______ 11 32.4 62 19.7 6 7.4 6 12.0 1 50.0 3 42.8 89 17.9 Sume_ 3 8.8 33 10.5 4 4.9 5 10.0 1 14.3 46 9.3 II asvnd AflflLS 17L Rural— 4 11.8 62 19.7 5 6.2 12 24.0 1 14.3 Combination3 _____ __ 8 2.5 3 3.7 8 16.0 Other4 _____._ l 2.9 34 10.8 46 56.8 1 2.0 2 28.6 __ 34 100.0 315 100.0 81 100.0 50 100.0 2 100.0 7 100.0 TotaL 8 8 100.0 100.0 84 19 92 497 16. 9 3.8 18.5 100.0 lNPs for this presentation are them providing primary care. 200:” includes industry, airport clinics, and faculty in an Air Force nurse midwifery program. s(.‘ornln'mztiorn includes two or more of the selected practice setting locations. ‘ Oflwr includes military installations, VA hospitals, industry, college/university mpuses, Indian reservations, religious communities, and construction sites. sThree NPs completing certificate programs did not supply information on practice setting location. SH'IEIVJ. 9L 76 STUDY PHASE II Table 50.—Average percent of patients in selected income categories served by the practice,l by specialty and type of NP program Patients’ income categories and type of program <$4,000 $4,000—15,000 >$15,000 Total Specialty Pct. Pct. Pct. No. Pct. Certificate Pediatric 54. 5 38. 5 7.0 162 100.0 Midwifery _______.._ 61.0 33.4 5.6 9 100.0 .Mabernitym______ ________ _ 45.9 45. 9 8.2 22 100.0 Family__________ 51.5 39.3 9.2 91 100.0 Adult _____________________ 53.5 34. 6 1 1.9 72 100. 0 Psychiatric _______ —— -- - - — Total ________________ __ 53.1 38.3 8.6 356 100.0 Master's Pediatric _______-_____,_____ 27. 9 60. 7 11.4 7 100.0 Midwifery ___—__ 58.8 36.4 4.8 23 100.0 Maternity 54.1 37.8 8.1 3 100.0 Family __ ________ __ 54.6 35.5 11.5 39 100.0 Adult ___—___ 49. 9 43.8 6.3 13 100.0 Psychiatric .____________________ 28.3 56.7 15.0 3 100.0 Total __________ 51. 7 39. 5 8.8 88 100.0 Total2 Pediatric ____________ 53.1 49.9 7.0 169 100.0 Midwifery ___________ 59.4 35.6 5.0 32 100.0 Maternity______ ________ 46.9 44.9 8.2 25 100.0 Family _____ 52.2 38.0 9.8 130 100.0 Adult _____________ 53.0 36.0 11.0 85 100.0 Psychiatric __ 28.3 56. 7 15.0 3 100.0 Total ___-_---_._______________ 52.9 38.5 8.6 444 100.0 1The practices reported on for this presentation correspond to the NPs providing primary care. ”Forty-seven NPs completing certificate programs and nine NPs completing master‘s programs did not supply information on income of patients served. Table 51.—NPs,l by whether they were the first to work in a specific practice setting, specialty, and type of NP program Specialty and type of program Pediatric Midwifery Maternity Family Adult Psychiatric Total No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate First NP _ 96 56.8 4 44.4 12 50.0 75 73.5 65 69.1 -- - 252 63.3 Not first NP____.._______ 73 43.2 5 55.6 12 50.0 27 26.5 29 30.9 — — 146 36.7 Total __ 169 100.0 9 100.0 24 100.0 102 100.0 94 100.0 — — 398 100.0 Master‘s First NP__..__.-_--_-___-___.______ 5 71.4 7 28.0 2 50.0 29 65.9 10 71.4 2 66.7 55 56.7 Not first NP___ 2 28.6 18 72.0 2 50.0 15 34.1 4 28.6 1 33.3 42 43.3 Total __.— ______ 7 100.0 25 100.0 4 100.0 44 100.0 14 100.0 3 100.0 97 100.0 Total2 First NP 101 57.4 11 32.4 14 50.0 104 71.2 75 69.4 2 66.7 307 62.0 Not first NP __ 75 42.6 23 67.6 14 50.0 42 28.8 33 30.6 1 33.3 188 38.0 Total ______________._ _________ _. 176 100.0 34 100.0 28 100.0 146 100.0 108 100.0 3 100.0 495 100.0 1NPs for this presentation are those providing primary care. 2Five NPs completing certificate programs did not supply information on whether they were the first to work in a specific practice setting. SEI'IHVJ. LL Table 52.—NPs,l by number of years the practice provided patient care, specialty, and type of NP program Specialty and type of program Years patient Pediatric Midwifery Maternity Family Adult Psychiatric Total care provided by the practice No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. N o. Pct. No. Pct. Certificate <1 13 7.7 1 11.1 2 8.0 5 4.9 7 7.4 28 7.0 1—5 49 29.0 2 22.2 8 32.0 39 38.2 19 20.2 117 29.3 >5 107 63.3 6 66.7 15 60.0 58 56.9 68 72.4 254 63.7 Total _._______._--____ _____ _ 169 100.0 9 100.0 25 100.0 102 100.0 94 100.0 399 100.0 Master’s <1 1 14.3 1 4.2 2 50.0 3 6.8 3 21.4 10 10.4 1—5 2 28.6 5 20.8 1 25.0 20 45.5 5 35.7 1 33.3 34 35.4 >5 4 57.1 18 75.0 1 25.0 21 47. 7 6 42.9 2 66. 7 52 54.2 Total _____________ 7 100.0 24 100.0 4 100.0 44 100.0 14 100.0 3 100.0 96 100.0 Total2 <1 14 7.9 2 6.1 4 13.8 8 5.5 10 9.3 38 7.7 1-5 51 29.0 7 21.2 9 31.0 59 40.4 24 22.2 1 33.3 151 30.5 >5 111 63.1 24 72.7 16 55.2 79 54.1 74 68.5 2 66.7 306 61.8 Total _——. 176 100.0 33 100.0 29 100.0 146 100.0 108 100.0 3 100.0 495 100.0 lNPs for this presentation are those providing primary care. 2Five NPs completing certificate programs did not supply information on the number of years the practice provided patient care. 11 asvnd Adams 8 L Table 53.-—NPs,l by whether or not NP position was planned when the practice was established, specialty, and type of NP program Specialty and type of program Pediatric Midwifery Maternity Family Adult Psychiatric Total NP position No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. N0. Pct. No. Pct. Certificate Planned ___________.__-_. 42 25.0 1 1 1. 1 6 25.0 33 32.7 21 22.3 —- — 103 26.0 Not planned ______ ____________ _ 126 75.0 8 88.9 18 75.0 68 67.3 73 77.7 -- — 293 74.0 Total _____________________________ 168 100.0 9 100.0 24 100.0 101 100.0 94 100.0 — -- 396 100.0 Master’s Flamed -__________ _____________ _ 1 14.3 6 26.1 1 25.0 12 27.3 6 42.9 26 27.4 Not planned -___ ___________ _ 6 85.7 17 73.9 3 75.0 32 72.7 8 57.1 3 100.0 69 72.6 Total _________.. 7 100.0 23 100.0 4 100.0 44 100.0 14 100.0 3 100.0 95 100.0 Total2 Flamed ___________ ____________ _ 43 24.6 7 21.9 7 25.0 45 31.0 27 25.0 . . . .. . 129 26.3 Not planned _— ______ 132 75.4 25 78.1 21 75.0 100 69.0 81 75.0 3 100.0 362 73.7 Total ___.________--.__ _________ 175 100.0 32 100.0 28 100.0 145 100.0 108 100.0 3 100.0 491 100.0 lNPs for this presentation are those providing primary we, 2Seven NPs completing certificate programs and two NPs completing master's programs did not supply information on whether or not an NP position was planned when the practice was established. 6; smavm ‘80 STUDY PHASE II Table 54.—NPs,I by whether or not NP position was planned when the practice was established, number of years the practice has provided patient care, and type of NP program NP position and type of program Years patient Planned Not planned Total care provided by the practice No. Pct. No. Pct. No. Pct. Certificate <1 20 71.4 8 28.6 28 100.0 1—5 73 63.5 42 36.5 115 100.0 >5 10 4.0 243 96.0 253 100.0 Total 103 26.0 293 74.0 396 100.0 Master‘s <1 6 60.0 4 40.0 10 100.0 1—5 17 50.0 17 50.0 34 100.0 >5 3 5.9 48 94.1 51 100.0 Total 26 27.4 69 72.6 95 100.0 Total2 <1 26 68.4 12 31.6 38 100.0 1—5 90 60.4 59 39.6 149 100.0 >5 13 4.3 291 95.7 304 100.0 Total 129 26.3 362 73.7 491 100.0 lNPs for this presentation are those providing primary care. zSueven NPs completing certificate programs and two NPs completing master‘s programs did not supply information on the number of years the practice provided patient care, whether or not an NP position was planned when the practice was established, or both. Table 55.—NPs’ titles in employment settings, by type of NP program Type of program Certificate Master’s Total Title ‘ No. Pct. No. Pct. N0. Pct. Nurse practitioner ______________________..____ 272 67.8 30 27.3 302 59.0 Nurse associate _ ______________________________ 42 10.4 1 0.9 43 8.4 Nurse clinician _________________________________ 7 1.7 24 21.8 31 6.1 Clinical nurse specialist- 5 1.2 14 12.7 19 3.7 Nurse midwife __________________-____-_________ 10 2.5 24 21.8 34 6.6 Traditional title2 _____________________________ 66 16.4 17 15.5 83 16.2 Total3 _________________________________________ 402 100.0 110 100.0 512 100.0 1The titles listed below were frequently used with a term which reflects specialty (e. g. , family nurse associate, pediatric nurse practitioner, OB—GYN nurse clinician, medical-surgical clinical specialist). 2Respondents reported a great variety of titles with no NP connotation such as staff nurse, head nurse, school nurse, public health nurse, community health nurse, primary care nurse, outreach nurse, supervisor, administrator, instructor, coordinator, and director. For purposes of this presentation, these titles are referred to as traditional titles if they were the only titles used. aThirteen NPs completing certificate programs and seven N Ps completing master's programs did not supply informa- tion on their titles in their employment settings. Table 56.—NPs’ titles in employment settings, by titles most commonly used by the program to designate graduates and type of NP program Titles1 designating graduates and type of program Clinical Title in Nurse Nurse Nurse nurse Nurse Nurse employment setting practitioner associate clinician specialist midwife generalist Total Certificate Nurse practitioner____,.__________ 213 31 8 1 2 255 Nurse associate ______________________ 1 39 1 41 Nurse clinician ____ ________________ 2 1 3 l 7 Clinical nurse specialist __ 1 4 5 Nurse midwife__ _____________ 2 6 8 Traditional title2 ________________________ 45 6 2 3 2 2 60 Total ___._______ ______________ 263 78 14 7 9 5 376 Master’s Nurse practitioner_ _________________ 6 7 7 2 22 Nurse associate ___________________________ 1 1 Nurse clinician__._~ ______ _ 4 18 l 23 Clinical nurse specialist _______________ 2 1 10 13 Nurse midwife_ _____________________ 1 14 15 Traditional title2 _____________________ 4 4 4 12 Total ___-_ ______________ 12 . . . 32 22 20 . . . 86 Total3 Nurse practitioner __________ _ 219 31 15 7 3 2 277 Nurse associate ______________________ 1 39 2 42 Nurse clinician ___._.-_____ 6 1 21 1 1 30 Clinical nurse specialist ___________ _ 2 1 1 14 18 Nurse midwife ___ _____ _ 2 1 20 23 I8 smaw. Table 56.—NPs’ titles in employment settings, by titles most commonly used by the program to designate graduates and type of NP program—continued Titlesl designating graduates and type of program Clinical Title in Nurse Nurse Nurse nurse Nurse Nurse employment setting practitioner associate clinician specialist midwife generalist Total Traditional title2 ______________--__________ 45 6 6 7 6 2 72 Total _ _________________________________ 275 78 46 29 29 5 462 ‘The titles listed below were frequently used with a term which reflects specialty (e.g., family nurse associate, pediatric nurse practitioner, OB-GYN nurse clinician, medical-surgical clinical specialist). 2Respondents reported a great variety of titles with no NP connotation such as staff nurse, head nurse, school nurse, public health nurse, community health nurse, primary care nurse, outreach nurse, supervisor, administrator, instructor, coordinator, and director. For purposes of this presentation, these titles are referred to as traditional titles if they were the only titles used. aThirty-nine NPs completing certificate programs and 31 NPs completing master’s programs did not supply information on their titles in their employment settings, titles most commonly used by the programs to designate graduates, or both. 88 II EISVHd ROMS Table 57.—Percent of NPs engaged in the NP role only and in a combination NP and traditional nursing role, by specific functions and type of NP program Type of program Combination NP and traditional NP role only nursing role Certificate Master’s Total 1 Certificate Master’s Total 1 Functions N=243 N=63 N=306 N=153 N=44 N=197 NP functions2 Direct patient care (primary care) ______________________ 97.5 88.9 95.3 97.4 81.8 93.9 Coordinator or supervisor _________________________________ 20.6 33.3 23.2 38.1 18.2 25.9 Administrator 9.5 14.3 10.5 7.8 11.4 8.6 Consultant 24.7 25.4 24.8 23.5 31.8 25.4 Researcher 9. 9 12. 7 10. 5 5. 9 11.4 7.1 Teacher or clinical preceptor________________-__-__________ 26.7 61.9 34.0 18.3 56.8 26.9 Other3 10.3 6.3 9.5 6.5 6.8 6.6 Traditional nursing functions2 Stafl’ nurse (including staff PHN) _______________________ -- —- -- 56.9 20.5 48.7 Head nurse/team leader ____________________________________ -- -- -- 15.0 2.3 12.2 Coordinator or supervisor _________________________________ -- —- -- 32.7 18.2 29.4 Clinical specialist -_-________________--________________--______ — -- —— 7.2 15.9 9.1 Administrator -— —- -- 14.4 22. 7 16.2 Consultant -- -- —— 20.3 27.3 21.8 Researcher -- -- —- 7.8 15.9 9.6 Teacher -- -— -- 28. 1 63. 6 36.0 Other‘1 ' —- —— -- 9.2 4.5 8.1 ‘One NP completing a certificate program and one NP completing a master‘s program did not classify themselves as engaged in the NP role only or in a combination of the NP and the traditional nursing role. Fourteen NPs completing certificate programs and four NPs completing master’s programs engaged in the NP role only did not supply information on their NP functions. Four NPs completing certificate programs and five NPs completing master‘s programs engaged in a combination of the NP role and the traditional nursing role did not supply information on their NP functions, traditional nursing functions, or both. 2Categories are not mutually exclusive. 3 Other includes committee and community meetings and outreach, tests and lab work, paper work, and conferring with physicians. ‘ Other includes paper work, committee meetings, and tests and lab work. SEI'ISVJ. 88 Table 58.—Average hours per week NPs were engaged in the NP role only and in a combination NP and traditional nursing role, by specific functions and type of NP program Wpe of program Combination NP and traditional NP role only nursing role Functions Certificate Master" 5 Total 1 Certificate Master’s Total 1 NP functions 39.3 42.0 39.8 23.3 22.2 22.8 Primary care 34.0 28.1 32.8 19.4 16.3 18.7 Coordinator or supervisor ____ _______________ 1.0 2.7 1.3 1.6 .7 1.4 Administrator .4 .6 .5 .3 . 1 .2 Consultant 13 1.5 1.3 .7 1.0 .7 Researcher .3 .3 .3 .1 .1 . 1 Teacher or clinical preceptor_______ ___________ 1.5 8.6 2.9 .8 3.8 1.4 Other2 .8 .2 .7 .4 .2 .3 Traditional nursing functions ______________________ _ -- -- — 18.2 19.6 18.3 Staff nurse (including staff PHN) _____________ _-__ -- -- -- 7.3 2.2 6.2 Head nurse/team leader ________________ _ __ -- -- -- 2.1 .2 1.6 Coordinator or supervisor _________________________________ -- « -- 2.6 2.2 2.5 Clinical specialist -- -- -— .6 1.1 .7 Administrator -- —- -- .9 2.6 1.3 Consultant -- -- - .9 1.7 1.0 Researcher -- -- -~ .3 1. 1 .4 Teacher -— -- -- 3.0 8.2 4. 1 Other3 —- -- -- .5 .3 .5 NP and traditional nursing functions__._ __________ 39.3 42.0 39.8 41.5 41.8 41.1 lOne NP completing a certificate program and one NP completing a master‘s program did not classify themselves as engaged in the NP role only or in a combination of the NP and the traditional nursing role. Fourteen NPs completing certificate programs and four NPs completing master‘s programs engaged in the NP role only did not supply information on the percent of time spent on NP functions. Four NPs completing certificate programs and five NPs completing mster‘s programs engaged in a combination of the NP role and the traditional nursing role did not supply information on the percent of time spent on NP functions, percent of time spent on traditional nursing functions, or both. 2 Other includes committee and community meetings and outreach, tests and lab work, paper work, and conferring with physicians. 3Other includes paper work, committee meetings, and test and lab work. 11 EISVHd ACIDLS I78 TABLES 85 Table 59.—Selected combinations of NP functions, by type of NP program Type of program Certificate Master’s Total Selected NP functions2 No. Pct. No. Pct. No. Pct. Only primary care _____ - _ __ __- 211 52.9 30 26.8 241 47.1 Some primary care-.__ _ 177 44.4 64 57.1 241 47.1 and teaching _________________________________ 30 7.5 29 25.8 59 11.5 and consulting ____________________ 38 9.5 3 2.7 41 8.0 and coordinating _______________________ 36 9.0 5 4.5 41 8.0 and teaching, coordinating__ _______ 18 4.5 6 5.4 24 4.7 and teaching, consulting"; ______________ 17 4.3 7 6.2 24 4.7 and consulting, coordinating ____________ 15 3.8 4 3.6 19 3.7 and teaching, consulting, coordinat- ing _______________________________________ 23 5.8 10 8.9 33 6.5 No primary care ______________ , _____________ 1 1 2.7 18 16.1 29 5.8 only teachingw _________________________ 5 1.4 10 8.9 15 3.0 only consulting ___________________-______-___ 2 .5 2 1.8 4 .8 only coordinating ___________________ _. 1 .2 1 .2 only administering _________________ 1 .2 1 .2 only teachifig and consulting _-_______._- l .2 2 1.8 3 .6 only teaching and coordinating _________ 1 .2 2 1.8 3 .6 only teaching, consulting, coordinat- ing ___________________ _ _________ 2 1.8 2 .4 Total1 _____________________________________ 399 100.0 112 100.0 511 100.0 lSixteen NPs completing certificate programs and five N Ps completing master's programs did not supply information on their NP functions. 2Other functions such as administrator and researcher are not included in the combinations. 86 STUDY PHASE II Table 60.———NI"sl providing and not providing primary care in their current positions, by whether they provided direct patient care in their positions before NP preparation and type of NP program Provision of direct patient care in position before NP preparation and type of program Provision of primary care Provided Not provided Total in current position No. Pct. No. Pct. No. Pct. Certificate Provided ______________________________ 329 98.2 64 92.8 393 97.3 Not provided _________. 6 1.8 5 7.2 11 2.7 Total -_._________ ...... _. 335 100. 0 69 100. 0 404 100. 0 Master’s Provided _________ __________ 74 83.1 23 85. 2 97 83.6 Not provided ________— 15 i 16.9 4 14.8 19 16.4 Total _______________________________ 89 100.0 27 100.0 1 16 100.0 Total2 Provided _______________ _____ __ 403 95.0 87 90. 6 490 94.2 Not provided -_.________ _____ __ 21 5.0 9 9.4 30 5.8 Total _________._._-_-__________ 424 100. 0 96 100. 0 520 100. O 1This presentation is based on N Ps who were employed both before and after NP preparation. 2'l‘wo NPs completing certificate programs and one NP completing a master‘s program did not supply information on whether or not they provided direct patient care in their positions before NP preparation. Table 61.—NPs engaged full time and part time in NP functions, by specialty and type of NP program Specialty and type of program Pediatric Midwifery Maternity Family Adult Psychiatric Total Engaged in NP functions No. Pct. N0. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Full time (>35 hrs/wk) ____ 94 53.4 10 90.9 11 42.3 75 72.8 56 57.7 -- — 246 59.6 Part time (<35 hrs/wk) ______ 82 46.6 1 9.1 15 57.7 28 27.2 41 42.3 -- - 167 40.4 Total _______.____._.__‘_______ 176 100.0 11 100.0 26 100.0 103 100.0 97 100.0 -- — 413 100.0 Master's Full time (>35 hrs/Wk)_ ______ 4 44.4 18 62.1 2 50.0 26 52.0 9 52.9 3 50.0 62 53.9 Part time (<35 hrs/wk) -.__...___ 5 55.6 11 37.9 2 50.0 24 48.0 8 47.1 3 50.0 53 46.1 Total ______ 9 100.0 29 100.0 4 100.0 50 100.0 17 100.0 6 100.0 115 100.0 Total1 Full time (>35 hrs/wk)_ ____________ 98 53.0 28 70.0 13 43.3 101 66.0 65 57.0 3 50.0 308 58.3 Part time (<35 hrs/wk) —. 87 47.0 12 30.0 17 56.7 52 34.0 49 43.0 3 50.0 220 41.7 Total ________________ 185 100.0 40 100.0 30 100.0 153 100.0 1 14 100.0 6 100.0 528 100.0 "l\vo NPs completing certificate programs and two NPs completing master’s programs did not supply information on tne number of hours per week they were engaged in NP functions. L8 smavm 88 STUDY PHASE II Table 62.—NPs, by percent of total employed time they spent in NP functions and type of NP program Type of program Percent of time Certificate Master’s Total1 in NP functions No. Pct. No. Pct. No. Pct. l—25_____._.__________ __________ _. 26 6.3 5 4.3 31 5.9 26—50—_.___,___ 42 10.2 24 20.9 66 12.5 51-75__________________..__ 41 9.9 11 9.6 52 9.8 76-99...__..___________ 48 11.6 9 7.8 57 10.8 100_____..________ ______ _.._. 256 62.0 66 57.4 322 61.0 Total_—— 413 100.0 115 100.0 528 100.0 "l‘wo NPs completing certificate programs and two NPs completing master‘s programs did not supply information on the number of hours per week they were engaged in N P functions. Table 63.—NPs, by percent of total employed time they spent in NP functions, employment setting in which they spent most of their time in NP functions, and type of NP program Major employment setting and type of program Nonhospital Nonhospital School Extended Inhospital Ambulatory institutional community of care practice practice setting setting nursing facility Other1 Total Percent of time inNP functions No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate 1—50_____ _________ 3 13.6 29 11.7 18 22.5 12 26.6 2 66.7 2 50.0 2 18.2 68 16.5 51-99 4 18.1 47 19.0 23 3.8 13 28.9 2 18.2 89 21.5 100 .____.____ 15 68.3 172 69.3 39 48.7 20 44.5 1 33.3 2 50.0 7 63.6 256 62.0 Total__.—_ 22 100.0 248 100.0 80 100.0 45 100.0 3 100.0 4 100.0 11 100.0 413 100.0 Master's 1—50_—___ 4 22.3 16 23.2 7 50.0 2 50.0 29 25.2 51—99-..“ __________ _ 5 27.8 12 17.4 1 100.0 2 25.0 20 17.4 100 9 49.9 41 59.4 6 75.0 7 50.0 2 50.0 1 100.0 66 57.4 TotaL __ 18 100.0 69 100.0 1 100.0 8 100.0 14 100.0 4 100.0 1 100.0 115 100.0 Total2 1—50__ 7 17.5 45 14.2 18 22.2 12 Q6 9 52.9 4 50.0 2 16.7 97 18.4 51—99 __. 9 Q5 59 18.6 24 29.7 15 28.3 2 16.7 109 20.6 100-...______-___ 24 60.0 213 67.2 39 48.1 26 49.1 8 47.1 4 50.0 8 66.6 322 61.0 TotaL—____ 40 100.0 317 100.0 81 100.0 53 100.0 17 100.0 8 100.0 12 100.0 528 100.0 ‘Otherincludes industry, airport clinics, and faculty in an Air Force nurse midwifery program. 2'l‘wo NPs completing certificate programs and two NPs completing master’s programs did not supply information on the number of hours they were engaged in NP functions, employment setting, or both. SEI’IHVJ. 68 Table 64.-—NPs1 providing selected health care services, by specialty and type of NP program Specialty and type of program Pediatric Midwifery Maternity Family Adult Psychiatric Total Selected health care services No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Infant and child health care _ 143 83.1 3 11.5 3 2.9 -— — 149 37.1 Adult health care _____________________ 5 2.9 31 30.4 58 62.4 -- -- 94 23.4 Maternity care and/or family plan- ning_ ____________________________________ 7 77.8 17 65.4 2 2.0 1 1.1 -- -— 27 6.7 Two or more of the above_________ 24 14.0 2 22.2 6 23.1 66 64.7 34 36.5 -- — 132 32.8 Total ______________________________ _ 172 100.0 9 100.0 26 100.0 102 100.0 93 100.0 -- -- 402 100.0 Master’s Infant and child health care __________ 6 85.7 5 11.4 11 11.3 Adult health care __ ._._. 1 25.0 18 40.9 8 57.1 1 33.3 28 28 9 Maternity care and/or family plan- ning — _,.__ 17 68.0 1 25.0 2 4.5 20 20.6 Two or more of the above _______ _ 1 14.3 8 32.0 2 50.0 19 43.2 6 42.9 2 66.7 38 39.2 Total _ __________________ _ 7 100.0 25 100.0 4 100.0 44 100.0 14 100.0 3 100.0 97 100.0 Total2 Infant and child health care _____.__ 149 83.2 3 10.0 8 5.5 160 32.1 Adult health care ...__ ______________ 5 2.8 1 3.3 49 33.6 66 61.7 1 33.3 122 24.4 Maternity care and/or family plan— ning_ __________________________ 24 70.6 18 60.0 4 2.7 1 0.9 47 9.4 Two or more of the above____..._ 25 14.0 10 29.4 8 26.7 85 58.2 40 37.4 2 66.7 170 34.1 Total ____.-....___.__ _____ 179 100.0 34 100.0 30 100.0 146 100.0 107 100.0 3 100.0 499 100.0 lNPs for this presentation are those providing primary care. 2One NP completing a certificate program did not supply information on the type of health care provided. II asvnd Adams 06 Table 65.—NPs1 providing selected health care services, by employment setting in which they spent most of their time in NP functions Employment setting Nonhospital Nonhospital Extended Inhospital Ambulatory institutional community School of care practice practice setting settiii‘g nursing facility Other3 Total Selected health care services2 No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Infant and child health care______..____._ 6 17.1 97 30.7 31 38.3 26 52.0 160 32.1 Adult health care__ _ 11 31.5 66 20.9 24 29.6 7 14.0 7 100.0 7 87.5 122 24.4 Maternity care/family p1anning__...__.. _______ 14 40.0 24 7.6 2 2.5 6 12.0 1 50.0 47 9.4 Two or more of the above 4 11.4 129 40.8 24 29.6 11 22.0 1 50.0 1 12.5 170 34.1 Total.-.____.____ 35 100.0 316 100.0 81 100.0 50 100.0 2 100.0 7 100.0 8 100.0 499 100.0 lNPs for this presentation are those providing primary care. 2One NP did not supply information on the type of health care provided. aOther setting includes industry, airport clinics, and faculty in an Air Force nurse midwifery program. 16 smavr. Table 66.—Percent of NPs1 providing infant and child health care who performed selected functions, by patient classification and type of NP program Function and type of program Initiate Order lab preventive- Obtain or Obtain or Perform tests/other Decide to Assume health oriented update soda]! update health physical diagnostic manage patient care teaching & family history history exam procedures or refer to MD management counseling Patient Certi- Mas- Certi~ Mas- Certi- Mas- Certi- Mas- Certi» Mas- Certi- Mas- Certi- Mas- classification ficate tei’s ficate ter‘s ficate tei’s flute ter's ficate ter‘s ficate ter's ficate ter’s For essentially well infants and children___~__‘ 93 83 95 81 63 49 86 73 -— —— —— —— 94 81 For infants and dlildren if potential problem is identified —— — 98 84 82 85 89 87 79 76 -- —— For 1-year-old children with low-grade fever rhinorrhea __ __ - ~ 8) 65 m 65 72 57 78 62 77 62 —— For children with blondlial asthma (mild attack) - —— 88 60 84 60 63 60 76 58 45 44 ~ -— Overall average 93 83 90 74 73 61 76 69 81 69 62 56 94 81 ‘This presentation is based on 258 certificate and 49 master's NPs providing primary care to infants and children. II asvna mums Z6 Table 67.—Average percent of physician consultation NPsI providing infant and child health care utilized when performing selected functions, by patient classification and type of NP program Function and type of prop-am Initiate Order lab preventive Obtain or Obtain or Perform tests/other Decide to Assume health oriented update social/ update health physical diagnostic manage patient care teaching 3: family history history exam procedures or refer to MD management counseling Patient Certi- Mas- Certi- Mas- Certi- Mas Certi- Mas- Certi- Mas- Certi— Mas— Certi- Mas— chmifieation ficate ter‘s ficate tex’s ficate ter‘s flute ter‘s ficate ter’s ficate tei’s ficate tei’s For mntially well infants and children 9 5 10 5 18 8 15 7 — —— —~ —- 10 4 For infants and children if potential problem is identified -— — 20 13 24 23 as 25 31 28 30 29 —— — For 1-year-old children with low—grade fever rhinon'hefl -- —— 12 4 l4 6 18 9 19 ll 17 13 —— ~ For children with bronchial asthma (mild attack) -— — 24 10 27 22 33 29 43 38 44 50 -~ Overall average 9 5 16 8 20 14 22 18 31 26 24 22 10 4 ‘This presentation is based on 258 certificate and 49 master's NPs providing primary care to infants and children. SS’IHVL 86 Table 68.——Percent of NPs1 providing maternity care/family planning who performed selected functions, by patient classification and type of NP program Function and type of program Obtain or Order Decide to update Obtain or lab work Initiate manage Assume Place (2) social/ update Perform Perform at the health patient health patient on family health physical pelvic appropriate teaching & or refer care oral contra- Insert history history exam exam intervals counseling to MD management ceptives IUD 3 m B m 8 m 8 m % w 3 m 3 gm 3 m 3 u: 3 m 8 é a E a é a 5 <3 é a E a E a E a E <3 é 1 75 77 76 75 50 60 36 53 62 70 77 78 — —- _ — — x e — 2 __ 75 77 76 75 57 60 35 45 62 70 77 73 -- —- —— ~ -— ~ — ~ 3 — ~ ~ * 51 58 32 49 — ~ — s ~ -- -— e — « _ _ 4 — — — — 49 58 33 53 — — — — — ~ — — ~ — _ _ 5 - —— - —- 44 64 43 64 — —« ~ — —~ —~ ~ —- fl -» ~— - 6 —- ~ —— —- —~ ~ 80 82 76 80 — 7 —— — — — — —— —~ — ~— — —- 61 68 34 36 — —— —— — 8 91 97 94 $77 92 83 93 — — 94 97 — —— —~ —- 75 88 25 48 9 83 87 85 86 57 66 45 61 62 70 86 88 71 75 55 58 75 88 25 48 1This presentation is based on the 159 certificate and 60 master’s N Ps providing primary care to maternity/family planning patients. 2Patient classification: 1 = maternity 2 = maternity, initial examination 3 = maternity, second trimester 4 = maternity, third trimester 5 = maternity, postpartum 6 = symptomatic complaints 7 = severe symptomatic complaints 8 = family planning patients 9 = overall average II SSVHd AGILLS v6 Table 69.—Average percent of physician consultation NPs1 providing maternity care/family planning utilized when performing selected functions, by patient classification and type of NP program Function and type of program Obtain or Order Decide to update Obtain or lab work Initiate manage Assume Place (2) social/ update Perform Perform at the health patient health patient on family health physical pelvic appropriate teaching & or refer care oral contra- Insert history history exam exam intervals counseling to MD management ceptives IUD 8 8 -: E a g a *3 4: i a ‘3 1': i a: g a i 42 ‘3 2 3 s 2 s s s s 3 s :3 g "a 8 “a s a s s 3 3 E 3 § 5 E 3 § 3 E a z :3 é; ,3 3 e3 5 3 § 1 _ 13 8 13 8 24 14 26 15 20 1o 13 6 ~ —— -- -- — -- — 2 _______ 13 8 13 8 22 12 34 18 2o 10 13 -— —— ~ — -- — -- ~ 3 ~ -- ~ — 20 12 17 12 —— -- — -- — — ~ — ~ — — ~ 4“ ~ ~ — ~ 3 14 34 13 u s — ~ ~ —- ~ —- — ~ 5 ~ — ~ — 25 17 a 16 — — ~ ~ — — ~ a ~ —— — — 6 x — ~ — ~ — — — ~ — ~ — — 19 24 as 26 — 7__ __ ~ -- —~ —— —— —— — —~ —- —— —— 68 75 73 72 ~ —- — — 8 11 7 12 7 14 11 13 11 — — 1o 7 — ~ ~ — 23 23 16 23 9 12 7 13 7 22 13 21 14 20 10 ll 6 41 47 39 41 23 23 16 23 1This presentation is based on the 159 certificate and 60 master‘s NPs providing primary care to matemity/family planning patients. 2Patient classification: 1 = maternity 2 = maternity, initial examination 3 = maternity, second trimester 4 = maternity, third trimester 5 = maternity, postpartum 6 = symptomatic complaints 7 = severe symptomatic complaints 8 = family planning patients 9 = overall average 96 smaw. Table 70.—Percent of NPs1 providing adult health care who performed selected functions, by patient classification and type of NP program Function and type of program Obtain or Order Decide Initiate update Obtain or lab to manage Assume preventive— (2) social/ update Perform tests/other patient health oriented family health physical diagnostic or refer care teaching & Alter Alter history history exam procedures to MD management counseling diet dosage . . .- E a , . . . .2 . a . 5 § <3 é a E a 5i a g :3 i <3 E 5 E 8 § 1 _____ 96 100 100 97 82 85 89 82 - —— —~ ~ 99 98 — — -— - 2_ _, —— -- 100 95 95 91 91 91 94 96 91 93 97 98 —— —- — — 3 __ — ~ 97 91 95 86 90 82 95 88 91 86 -- —— —— ~ 4 __________ _______ __ — — 99 86 95 83 87 79 88 81 86 79 —— —~ — — — — 5 ________ — -- 94 88 91 86 84 83 84 81 71 76 88 85 83 75 56 67 6 ~ —- 91 84 87 77 79 74 76 72 68 82 81 76 72 54 61 7______~___ —— —— 93 81 90 78 85 74 83 76 —- 85 77 67 69 49 58 8 _____________ __ —— —— 88 83 84 79 78 76 76 76 —~ —— ~ —— 66 72 51 61 9 95 100 95 88 91 83 86 80 85 81 80 81 90 88 73 72 52 62 1This presentation is based on the 213 certificate and 59 master’s NPs providing primary care to adult patients. 2Patient classification: 1 = essentially well adults 2 = adults if potential problem identified 3 = primary complaint of nasal congestion and rhinorrhea 4 = primary complaint of chest pain 5 = asymptomatic with hypertension 6 = symptomatic with hypertension 7 = diabetic stabilized on insulin therapy 8 = on oral hypoglycemic agents 9 = overall average 96 II EISVHd AGILLS Table 7l.—Average percent of physician consultation NPsl providing adult health care utilized when performing selected functions, by patient classification and type of NP program Function and type of program Obtain or Order Decide Initiate update Obtain or lab to manage Assume preventive- (2) social/ update Perform tests/other patient health oriented family health physiml diagnostic or refer care teaching & Alter Alter history history exam procedures to MD management counseling diet dosage 3 m 3 m 3 m 3 m 3 m 3 m 3 m 3 a 3 m e; 3“ .3 :33 “g g 15 g 2»: g s «3 s g 1,: g :2» a E 3 § 5 3 a E s E a Q 8 E a E a E 1 15 14 15 15 23 17 17 16 — — -- - 15 ll — — — - 2 -— — 21 16 28 23 30 26 31 30 32 30 19 12 —- — — ‘- 3 — - 15 12 18 14 l7 l3 19 17 Z) 18 — - -- — 4 -— — 30 19 35 30 38 34 45 31 a — — — —— —- —- 5 W —- —— 20 14 24 18 E 20 39 34 35 29 24 22 25 15 53 49 6 __._______________,____ — — 2'7 16 33 22 35 47 41 43 29 32 18 31 19 62 60 7 — — 20 12 21 15 29 15 41 31 -— 23 12 38 24 66 54 8 — -— 21 12 a 13 27 16 39 35 —- -— ~ — 33 21 60 66 9 15 14 21 15 26 19 w 21 37 33 31 27 22 15 31 19 60 57 ‘This presentation is based on the 213 certificate and 59 master's NPs providing primary care to adult patients. 2Patient classification: = essentially well adults 2 = adults if potential problem identified 3 = primary complaint of nasal congestion and rhinorrhea 4 = primary complaint of chest pain 5 = asymptomatic with hypertension 6 = symptomatic with hypertension 7 = diabetic stabilized on insulin therapy 8 = on oral hypoglycemic agents 9 = overall average SGI'IHVJ. 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"Em vummmsnwsoz E6 $58 Edimim «.135 $3. 3.3m “5.85% mm E53 :8: 9m 25.62. 3.35:5 mvmomma $138? 100 STUDY PHASE II Table 74.—Percent of pediatric NPs1 providing selected types of care to specific categories of patients, by type of NP program Care provided2 and type of program Well/ For Categories health For emotional/ of assess- physical mental Family Mater- Emer- patients ment illness health planning nity gency Certificate N = 169 Infants _________________ 75. 7 64. 5 40.2 -- -- 22. 5 Children _____________ 89.3 74.0 60.4 -- -- 34.9 Adolescents _________ 68.6 59. 2 49.1 25.4 13.6 30.2 Adults ________________ 10.6 10.6 9.5 8.3 8.9 9.5 Elderly ________________ 3.6 4.7 3.0 -- -- 4.7 Master’s N = 7 Infants ________________ 100.0 100.0 71.4 -- -- 42.9 Children ___________ 85. 7 85.7 71.4 -- -- 28.6 Adolescents ________ 57.1 71.4 71.4 28.6 28.6 Adults __________________ Elderly__ ___________ __ -- -- lNPs for this presentation are those providing primary care. ”Three NPs completing certificate programs did not supply information on the types of care provided. Table 75.—Pediatric NPsl providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program Care provided by NPs2 and type of program Well/health For physical For emotional/ Family assessment illness mental health planning Maternity Emergency Asa Asa As a Asa Asa Asa‘ pct. of pct. of pet. of pct. of pct. of pct. of Categories No. practices No. practices No. practices No. practices No. practices No. practices of of providing of providing of providing of providing of providing of providing patients NPs such care NPs such care NPs such care NPs such care NPs such care NPs such care Certificate Infants _____________________ 128 98.5 109 92.4 68 88.3 —- -- -- —- 38 56.7 Children __________________ 151 96.8 125 91.9 102 87.9 -- -- -- -- 59 64.8 Adolescents _______________ 1 16 87. 2 100 82.6 83 75. 5 43 59.7 23 46.9 51 58.6 Adults _________ 18 36.0 18 40.0 16 34.8 14 29.2 15 35.7 16 45.7 Elderly ________________ 6 14.3 8 22.2 5 14.3 -- -- -- -- 8 33.3 Master’s Infants _____________________ 7 100.0 7 100.0 5 100.0 -- -- -- -— 3 50.0 Children _____ _ 6 100.0 6 100.0 5 100.0 -- -- —- -- 2 40.0 Adolescents- _ 4 80.0 5 83.3 5 100.0 2 40.0 -- 2 33.3 Adults ______________________ -- -- —— -- —- -- Elderly _________________ -- -- -- -- -- ~- -- — 1NPs for this presentation are those providing primary care. 2One NP completing a certificate program did not supply information on the types of care provided by the practice and three NPs completing certificate programs did not supply infomlation on the types of care provided by the NP. SH'IHVJ. I01 102 STUDY PHASE II Table 76.—Percent of nurse midwives1 providing selected types of care to specific categories of patients, by type of NP program Care provided and type of program Well/ For Categories health For emotional/ of assess- phsical mental Family Mater- Emer- patients ment illness health planning nity gency Certificate N =9 Infants _______--____ 22.2 ... .. . -- -— Children _____________-_ ... ... . . . -- -- ... Adolescents _________ 22. 2 1 1.1 22.2 88.9 88. 9 44.4 Adults __________________ 33.3 22.2 33.3 100.0 88.9 44.4 Elderly __________-____ 1 1.1 11.1 11.1 -- -- Master’s N =25 Infants ______ 44.0 -- -- 8.0 Children _____ -- -- Adolescents _________ 36.0 24.0 16.0 80. 0 80.0 28. 0 Adults ____________ ._ 44.0 24.0 20.0 92.0 92.0 32.0 Elderly __ ______________ -- -- ‘Nurse midwives for this presentation are those providing primary care. Table 77.-—Nurse midwivesl providing selected types of care to specific categories of patients and the proportion of these midwives employed in practices providing such care, by type of NP program Care provided by NPs and type of program Well/health For physical For emotional/ Family assessment illness mental health planning Maternity Emergency Asa Asa Asa Asa Asa Asa pct. of pet. of pct. of pet. of pct. of pct. of Categories No. practices No. practices No. practices No. practices No. practices No. practices of of providing of providing of providing of providing of providing of providing patients NPs such care NPs such care NPs such care NPs such care NPs such care NPs such care Certificate Infants _____________________ 2 66.7 -— -- —— -- Children __________________ -- -- -- — Adolescents--- 2 40.0 1 25.0 2 66.7 8 100.0 8 100.0 4 80.0 Adults ------------------ 3 50.0 2 40.0 3 75.0 9 100.0 8 100.0 4 80.0 Elderly --__-___-----_--_--_ 1 50.0 1 50.0 1 100.0 — -— -- -- Master’s Infants --------------------- 11 84.6 -- -- -- -- 2 28.6 Children-__ ____________ -- -- -- -- Adolescents -------------- 9 75.0 6 54.5 4 50.0 20 90.9 20 100.0 7 63.6 Adults_ ------------------- 11 78.6 6 54.5 5 55.6 23 92.0 23 100.0 8 72.7 Elderly ------------------- -- .- -- -- 1Nurse midwives for this presentation are those providing primary care. SEI'IHVJ. 801 Table 78.—Percent of maternity NPsl providing selected types of care to specific categories of patients, by type of NP program Care provided and type of program Categories For For of Well/health physical emotional/ Family patients assessment illness mental health planning Maternity Emergency Certificate N =26 Infants _____________________ 23.1 7.7 11.5 -- -- Children __________________ 15.4 7.7 7. 7 -- -- 3.8 Adolescents -----__________ 42.3 26.9 19. 2 65.4 50.0 19.2 Adults _______ 61.5 34.6 23.1 84.6 57.7 23.1 Elderly ____________________ 26. 9 19.2 15.4 -- -- 3. 8 Master’s N =4 Infants _____ ____ -~ -- Children _____ ____ 25. 0 .. . . .. -- —- ... Adolescents- ____________ 75.0 50.0 75.0 100.0 75.0 25.0 Adults ____________________ .. 75.0 75. 0 75. 0 100. 0 75. 0 25. 0 Elderly ____________________ -- -- II asvnd Adams {701 lNl’s for this presentation are those providing primary care. Table 79.—Maternity NPs1 providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program Care provided by NPs and type of program Well/health For physical For emotional/ Family assessment illness mental health planning Maternity Emergency Asa Asa Asa Asa Asa Asa pct. of pct. of pet. of pet. of pet. of pet. of Categories No. practices No. practices No. practices No. practices No. practices No. practices of of providing of providing of providing of providing of providing of providing patients NPs such care NPs such care NPs such care NPs such care NPs such care NPs such care Certificate Infants _. ________________ 6 75.0 2 66.7 3 75.0 -- -- -- -- Children ________________ 4 66.7 2 66.7 2 66.7 -- -- -— —- 1 50.0 Adolescents ________ _ 11 78.6 7 63.6 5 62.5 17 85.0 13 86.7 5 71.4 Adults ____________-.___ 16 94.1 9 75.0 6 75.0 22 95.7 15 88.2 6 66.7 Elderly- ____________ 7 87.5 5 71.4 4 80.0 -- -- -- -- 1 25.0 Master’s Infants_ ______________ _ -- -- — -- -- -- -— Children _________________ _ 1 100.0 -- — -- -- Adolescents _________ 3 100.0 2 66.7 3 100.0 4 100.0 3 75.0 1 50.0 Adults ________________ 3 100.0 3 100.0 3 100.0 4 100.0 3 75.0 1 50.0 Elderly ________ ___,__ -- -- -- -- ‘NPs for this presentation are those providing primary care. SEI'IHVL 901 Table 80.—Percent of family NPs1 providing selected types of care to specific categories of patients, by type of NP program Care provided2 and type of program Categories For For of Well/health physical emotional/ Family patients assessment illness mental health planning Maternity Emergency Certificate N = 101 Infants _____________________ 54.5 59.4 26.7 -- -- 35.6 Children _________ __ 56.4 58.4 37. 6 -- —— 38.6 Adolescents _--_ ___ 73.3 75.2 60.4 53.5 38.6 49.5 Adults _____________________ 87.1 94.1 77.2 56.4 40.6 66.3 Elderly _____________________ 76.2 80.2 63.4 -- -- 56.4 Master’s N =43 Infants __-_-_____-______.._ 41.9 44.2 23.3 -— -- 16.3 Children _____ 46. 5 48.8 32. 6 -- -- 18. 6 Adolescents _____________ 69.8 76. 7 62.8 41 . 9 16.3 25. 6 Adults _______--_____--______ 74. 4 79. 1 76.7 51.2 20. 9 27.9 Elderly __________________ 67 .4 72.1 67.4 -- -- 27.9 1NPs for this presentation are those providing primary care. 2One NP completing a certificate program and one NP completing a master’s program did not supply information on the types of care provided. II EISVHd 501118 901 Table 8l.—Family NPs1 providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program Care provided by NPs2 and type of program Well/health For physical For emotional/ Family assessment illness mental health planning Maternity Emergency Asa Asa Asa Asa Asa Asa pct. of pct. of pct. of pct. of pct. of pct. of Categories No. practices No. practices N0. practices No. practices N0. practices No. practices of of providing of providing of providing of providing of providing of providing patients NPs such care NPs such care NPs such care NPs such care NPs such care NPs such care Certificate Infants ___________________-_ 55 83.3 60 88.2 27 69.2 -- -- -- -- 36 64.3 Children _-_--______________ 57 86.4 59 86.8 38 74.5 -- —- —— -— 39 70.9 Adolescents _ ____ 74 93. 7 76 92.7 61 88. 4 54 87.1 39 75.0 50 71.4 Adults __-__ ____ 88 97.8 95 99.0 78 92. 9 57 83.8 41 74. 5 67 80. 7 Elderly _____________________ 77 96.3 81 95.3 64 91.4 —- -— -- -- 57 77.0 Master’s Infants _-__ ____ 18 72.0 19 70.4 10 47.6 -- -- —- -— 7 46.7 Children ____ ____ 20 76.9 21 75.0 14 66.7 —- —- -- —— 8 50.0 Adolescents ____________-_- 30 90.9 33 91.7 27 84. 4 18 75.0 7 50.0 1 1 61.1 Adults ______________________ 32 100.0 34 97.1 33 94.3 22 91.7 9 56.3 12 70.6 Elderly ____________________ 29 96.7 31 93.9 29 93.5 -- —— -- —— 12 75.0 lNPs for this presentation are those providing primary care. zone NP completing a certificate program and one NP completing a master’s program did not supply information on the types of care provided by the NP. SEI’IEIVJ. L01 Table 82.—Percent of adult NPs‘ providing selected types of care to specific categories of patients, by type of NP program Care provided and type of program Categories For For of Well/health physical emotional/ Family patients assessment illness mental health planning Maternity Emergency Certificate N =94 Infants _______ 12.8 11.7 3.2 -- -- 11.7 Children ________________ 13.8 17.0 5.3 -- -- 19. 1 Adolescents _____________ _ 56.4 60.6 47.9 30.9 9.6 48.9 Adult ___ ________ 83.0 88.3 71.3 43.6 19.1 66.0 Elderly ________ __ 51.1 59.6 46.8 -- -- 44.7 Master’s N = 14 Infants ____________________ 28.6 28.6 28.6 -- -- 28.6 Children ___ __________ 42.9 42.9 35.7 -- — 35.7 Adolescents ___________ 57.1 64. 3 57. 1 50.0 14.3 35. 7 Adult _________________ 92.9 100.0 92.9 50.0 14.3 50.0 Elderly __________________ 92.9 100.0 92.9 -- -- 50.0 n asvnd mums 801 ‘NPs for this presentation are those providing primary care. Table 83.—Adult NPsl providing selected types of care to specific categories of patients and the proportion of these NPs employed in practices providing such care, by type of NP program Care provided by NPs and type of program Well/health For physical For emotional/ Family assessment illness mental health planning Maternity Emergency As a As a As a As a As a As a pet. of pct. of pct. of pct. of pct. of pet. of Categories No. practices No. practices No. practices No. practices No. practices No. practices of of providing of providing of providing of providing of providing of providing patients NPs such care NPs such care NPs such care NPs such care NPs such care NPs such care Certificate Infants ____________________ 12 50.0 11 37.9 3 23.1 -- -- -- -- 11 47.8 Children ______ _____ 13 50.0 16 51.6 5 26.3 -- -- —- -- 18 69.2 Adolescents _______________ 53 88.3 57 86.4 45 80.4 29 69.0 9 39. 1 46 88.5 Adults _____ 78 96.3 83 97.6 67 89.3 41 78.8 18 64.3 62 87.3 Elderly ___________________ 48 94.1 56 96.6 44 89.8 -- -- -— -- 42 87.5 Master’s Infants ___ _-_-_____ 4 50.0 4 50.0 4 66.7 -- -- —- -- 4 80.0 Children _ _____ ___- 6 75.0 6 75.0 5 71.4 -- —- -- —- 5 83.3 Adolescents _______________ 8 88.9 9 90.0 8 88.9 7 100.0 2 66.7 5 71.4 Adults ___________________ 13 100.0 14 100.0 13 100.0 7 100.0 2 66.7 7 63.6 Elderly _____________________ 13 100.0 14 100.0 13 100.0 -- -- -- -- 7 63.6 1Nl’s for this presentation are those providing primary care. SEI'IHVJ. 60I Table 84.—NPs,l by the average number of patients they saw per day in the employment setting in which they spent most of their time functioning as NPs, specialty, and type of NP program Specialty and type of program Average no. Pediatric Midwifery Maternity Family Adult Psychiatric Total patients per day No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. N0. Pct. N o. Pct. Certificate 18 11.2 1 11.1 7 28.0 7 6.9 8 8.9 —— —- 41 10.6 72 44.7 6 66.7 3 12.0 23 22.8 29 32.2 -- -- 133 34.5 32 19.9 1 11.1 8 32.0 38 37.6 23 25.5 —— -- 102 26.4 18 11.2 4 16.0 23 22.8 20 22.2 —— -- 65 16.8 16 9.9 1 11.1 2 8.0 8 7.9 5 5.6 -- -- 32 8.3 5 3.1 1 4.0 2 2.0 5 5.6 -- -- 13 3.4 161 100.0 9 100.0 25 100.0 101 100.0 90 100.0 -- -- 386 100.0 Master’s 1 14.3 5 22.7 1 25.0 7 16.3 3 21.4 2 66.7 19 20.4 3 42.8 4 18.2 2 50.0 22 51 1 7 50.0 1 33.3 39 41.9 2 28.6 6 27.3 7 16.3 3 21.4 18 19.4 5 22.7 1 25.0 5 11.6 1 7.2 12 12.9 2 9.1 2 47 4 4.3 1 14.3 1 1.1 7 100.0 22 100.0 4 100.0 43 100.0 14 100.0 3 100.0 93 100.0 Total2 19 11.3 6 19.4 8 27.6 14 9.7 11 10.6 2 66.7 60 12.5 75 44.7 10 32.2 5 17.2 45 31.3 36 34.6 1 33.3 172 35.9 34 20.2 7 22.6 8 27.6 45 31.3 26 25.0 120 25.1 18 10.7 5 16.1 5 17.2 28 19.4 21 20.2 77 16.1 16 9.5 3 9.7 2 6.9 10 6.9 5 4.8 36 7.5 n asvnd mars 011 >30 _________________________________________ 6 3.6 l 3.5 2 1.4 5 4.8 Total ______________________________ 168 100.0 31 100.0 29 100.0 144 100.0 104 100.0 3 100.0 lNli’s for this presentation are those providing primary are. 2Seventeen NPs completing certificate programs and four NPs completing master’s programs did not supply information on the average number of patients they saw per day. 14 479 2.9 100.0 SEI'ISVJ. III 112 STUDY PHASE II Table 85.—NPs,l by discipline of persons in the practice who usually saw new patients and patients on followup visits, by type of NP program Type of program Patients on Discipline of person in New patients followup visits the practice who usually saw patients No. Pct. No. Pct. Certificate MD 25 6.3 13 3.3 NP 122 30.7 109 27.7 Either MD or NP _____________________________________ 203 51.1 246 62.4 Both MD and NP together or in sequence______ 46 11.6 22 5.6 Other2 1 0.3 4 1.0 Total 397 100.0 394 100.0 Master’s MD 8 8.2 5 5.3 NP 15 15.5 21 22.3 Either MD or NP ____________________________________ 59 60.8 64 68.2 Both MD and NP together or in sequence ______ 13 13.4 2 2.1 Other2 2 2.1 2 2.1 Total 97 100.0 94 100.0 Total3 MD 33 6.7 17 3.5 NP 137 27.8 133 27.3 Either MD or NP _____________________________________ 262 53.0 308 63.1 Both MD or NP together or in sequence ________ 59 11.9 24 4.9 Other2 3 0.6 6 1.2 Total 494 100.0 488 100.0 ‘NPs for this presentation are those providing primary care. 2 Other includes staff nurse, school nurse, or field representative. “Six NPs completing certificate programs did not supply information on both the discipline of the person in the practice who usually saw new patients and the discipline of the person in the practice who usually saw patients on followup visits. An additional six NPs completing certificate programs did not supply information on the discipline of the person in the practice who usually was the one to see patients on followup visits. TABLES 113 Table 86.—NP:sl reporting physician’s availability to discuss patient problems as they occurred, by type of NP program Type of program Certificate Master’s Total2 Physician’s availability No. Pct. No. Pct. No. Pct. Always physically present _-___-____-_______ 125 34.0 30 32.3 155 33.6 Not always physically present _____________ 243 66.0 63 67.7 306 66.4 Available by phone when not present physicially: Always-_--___-___-____________-______-______ 166 45. 1 47 50.4 213 46.2 Usually ___________________________________ 63 17.1 14 15.1 77 16.7 Sometimes -_______-______-__-_____________ 6 1.6 2 2.2 8 1.7 Seldom 4 1.1 4 0.9 Never _______________________________________ 4 1.1 4 0.9 Total 368 100.0 93 100.0 461 100.0 lNP’s for this presentation are those providing primary care. 2Thirty-five NPs completing certificate programs and four Nl’s completing master's programs did not supply informa- tion on whether a physician was physically present or whether a physician was available by phone if one were not physically present. Table 87.—NPs,1 by the frequency that a physician was physically present during the time that they were functioning as NPs, employment setting in which they spent most of their time as NPs, and type of NP program Frequency of physician’s presence and type of program Seldom or Always Usually Sometimes never Total Employment setting No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Inhospital practice 8 40.0 7 35.0 5 25.0 20 100.0 Ambulatory practice ____________________________________________ 94 39.4 87 36.4 35 14.6 23 9.6 239 100.0 Nonhospital institutional setting ____________________________ 12 17.4 20 29.0 19 27.5 18 26.1 69 100.0 Nonhospital community setting ____________________________ 10 25.0 12 30.0 9 22.5 9 22.5 40 100.0 School of nursing -- -- -- -- -- -- -- -- —- -- Extended care facility _______________________________________ 1 33.4 1 33.3 1 33.3 3 100.0 Other2 1 16.7 2 33.3 3 50.0 6 100.0 Total 125 33.2 129 34.2 69 18.3 54 14.3 377 100.0 Master’s Inhospital practice 8 61.5 3 23.1 2 15.4 13 100.0 Ambulatory practice____________________________________________ 20 29.4 33 48.5 10 14.7 5 7.4 68 100.0 Nonhospital institutional setting--- 1 100.0 1 100.0 Nonhospital community setting _________-___________________ 1 12.5 2 25.0 5 62.5 8 100.0 School of nursing 1 50.0 1 50.0 2 100.0 Extended care facility __-___-_-______-_________________________ 2 66.7 1 33.3 3 100.0 Other2 1 100.0 1 100.0 Total 30 31.3 40 41.6 20 20.8 6 6.3 96 100.0 Total3 Inhospital practice 16 48.5 10 30.3 7 21.2 33 100.0 Ambulatory practice_..-_____-___--___________--,-__-___________ 114 37.1 120 39.1 45 14.7 28 9.1 307 100.0 II EISVI-Id mums 17H Nonhospital institutional setting ____________________________ 12 Nonhospital community setting ____________________________ 11 School of nursing 1 Extended care facility ___________________________________ Other2 1 Total 155 17.1 22.8 50.0 14.3 32.8 21 14 169 30.1 29.2 50.0 16.7 28.6 35.7 19 14 89 27. 1 29.2 50.0 14.3 18.8 MN): 25.7 18.8 33.3 42.8 12.7 70 48 QM 473 100.0 100.0 100.0 100.0 100.0 100.0 lNPs for this presentation are those providing primary care. 2Otlwr includes industry, airport clinics, and faculty in an Air Force nurse midwifery program. ”Twenty-six NPs completing certificate programs and one NP completing a master’s program did not supply information on the frequency of a physician's prewnce while they were functioning as N Ps. SEITHVJ. 9H 116 STUDY PHASE II Table 88.—NPs,l by frequency with which a physician or nurse preceptor reviewed their records and type of NP program Type of program Frequency of Certificate Master’s Total2 record review No. Pct. No. Pct. No. Pct. Always __________________________________ 107 27.3 17 17.7 124 25.4 Usually _____________________________________ 81 20. 7 25 26.1 106 21.7 Sometimes ________________________________ 131 33.4 27 28. 1 158 32. 4 Seldom ______.___.___________________, 56 14.3 22 22.9 78 16.0 Never ________________________________________ 17 4.3 5 5.2 22 4.5 Total_______._____. ______________ 392 100.0 96 100.0 488 100.0 lNPs for this presentation are those providing primary care. 2 Eleven NPs completing certificate programs and one NP completing a master's program did not supply information on the frequency with which a physician or nurse precepbor reviewed their records. Table 89.—NPs" opinions as to ideal length and the actual length of each curricular component of NP preparation, by specialty and type of NP program Average length (in months) and type of program Certificate Master’s Total Internship/ Internship/ Internship/ Didactic Preceptorship Didactic Preceptorship Didactic2 Preceptorship3 Specialty Ideal Actual Ideal Actual Ideal Actual Ideal Actual Ideal‘ Actual Ideal“ Actual5 Pediatric __________________________ 5.0 4.1 6.6 5.4 12.5 16.6 7.8 -- 5.3 4.5 6.6 5.4 Midwifery______ 8.7 10.3 3.5 -— 12.9 16.3 5.0 -- 11.8 14.7 4.6 — 4.9 4.3 5.9 4.8 9.0 15.0 9.0 -- 5.4 5.7 6.3 4.8 Family ________________________ .. 7.4 6.5 7.2 6.3 10.9 13.2 7.7 2.8 8.4 8.5 7.3 5.8 Adult_._______. _____________ 4.3 3.0 8.8 6.6 11.8 17.4 9.4 3.0 5.2 4.9 8.8 6.6 Psychiatric ____ ______________ -- -- -— .. 17. 0 15. 3 7. 7 -- 17 . 0 15. 3 7. 7 -- Total _________________________________ 5.5 4.6 7.2 6.0 11.8 15.0 7.5 2.8 6.7 6.6 7.2 5.8 1N95 for this presentation are those providing primary care. 2The didactic portion includes a classroom and a clinical component. The clasroom component includes such activities as lectures and self-instruction. The clinical component includes relevant clinical observations and experiences and operates concurrently with the classroom component. 3The internship or preceptorship portion is a specified period of supervised clinical practice in patient assessment and management and is a requirement for completion of some programs. This is distinct from and follows the clinical experience ofiered concurrently with the didactic portion. ‘Thirty-four NPs completing certificate programs and 17 NPs completing master‘s programs did not supply information on ideal length of didactic portion of NP program. Fifteen NPs completing certificate programs and eight NPs completing master’s programs did not supply information on ideal length of internship/preceptorship portion of NP program. sActual length is based on responses from those NPs who had had internships or preceptorships in their NP programs. One hundred and sixteen NPs completing certificate programs and 80 NPs completing master's programs did not have internships or preceptorships in their NP program. SEI’IEIVJ. LII 118 STUDY PHASE II Table 90.—NPs, by reason(s) for choosing present position and type of NP program Type of program Certificate Master’s Total? N=409 N=110 N=519 Reason(s)‘ No. Pct. No. Pct. N0. Pct. Role autonomy (including practicing new skills _______________________________________ 275 67.2 73 66.4 348 67. 1 Setting offers a creative approach to health care delivery ________________________ 244 59.7 56 50.9 300 57.8 Location of employment-_1__________________ 165 40.3 42 38.2 207 39.9 Availability of adequate medical backup ________________________________________ 159 38.9 45 40.9 204 39.3 Training or educational opportunities ___ 162 39.6 41 37.3 203 39.1 Good salary and/or fringe benefits _______ 135 33.0 44 40.0 179 34.5 Work that is related to social problems. 111 27.1 24 21.8 135 26.0 Job security _____________________________________ 59 14.4 8 7.3 67 12.9 Opportunity for advancement ___- ____ 60 14.7 5 4.5 65 12.5 Only job available __________________ ____ 41 10.0 13 11.8 54 10.4 Returning to previous employer __________ 45 11.0 4 3.6 49 9.4 Opportunity to teach and develop cur- riculum for an NP program _____________ 26 6.4 21 19.1 47 9.1 Prestige _________-______________-__-__-_--_______ 21 5.1 9 8.2 30 5.8 1Categories are not mutually exclusive. 2Six NPs completing certificate programs and seven NPs completing master’s programs did not supply information on the reasons for choosing present NP position. TABLES 119 Table 91.—NPs, by most important reason for choosing present position and type of NP program Type of program Certificate Master’s Totall Most important reason No. Pct. No. Pct. No. Pct. Role autonomy (including practicing new skills) _________________________________________ 99 25.3 43 39.5 142 28.3 Setting offers a creative approach to health care delivery_____________-__________ 110 28.1 19 17.4 129 25.7 Location of employment___________-___-_____ 36 9.2 8 7.3 44 8.8 Availability of adequate medical backup _________________________________________ 16 4.1 3 2.8 19 3.8 Training and educational opportunities _ 37 9.4 8 7.3 45 9.0 Good salary and/or fringe benefits _______ 17 4.3 5 4.6 22 4.4 Work that is related to social problems_ 10 2.6 3 2.8 13 2.6 Job security _____________________________________ 9 2.3 9 1.8 Opportunity for advancement 2 .5 1 .9 3 .6 Only job available _________--____________-___-_ 19 4.8 8 7.3 27 5.4 Returning to previous employer __________ 33 8.4 2 1.8 35 7.0 Opportunity to teach and develop cur- riculum for an NP program _____________ 4 1.0 9 8.3 13 2.6 Total 392 100.0 109 100.0 501 100.0 1Twenty-three NPs completing certificate programs and eight NPs completing master’s programs did not supply information on the most important reason for choosing present NP position. Table 92.—Employer or supervisor respondents,‘ by discipline and type of NP program Type of program Certificate Master's Total Discipline No. Pct. No. Pct. No. Pct. Physician___________-_______--_______________-____ 192 58.2 43 54.4 235 57.4 Nurse _____________________________________________ 76 23.0 21 26.6 97 23.7 Nurse practitioner ____________________________ 28 8.5 10 12.7 38 9.3 Administrator _______ _ 29 8.8 2 2.5 31 7.6 Other2 ___-__________ _ 5 1.5 3 3.8 8 2.0 Total3_________-________________-_-_-__-_________ 330 100.0 79 100.0 409 100.0 1In a letter accompanying their questionnaires, the graduates were asked to give another questionnaire (which was also V enclosed) to their employers or professional supervisors at their place of employment. 2Other includes social worker, psychologist, personnel manager in industry, nutritionist, and teacher. aThree employers of graduates of certificate programs and two employers of graduates of master’s programs did not supply information on their disciplines. Table 93.—Employers, by reason(s) for employing the NP and type of NP program Type of program Certificate Master’s Total2 N =324 N =80 N =404 Reason(s) 1 No. Pct. No. Pct. No. Pct. To improve quality of care (in general) 308 95.1 67 83.8 375 92.8 To allow physician(s) to spend more time on complex cases 243 75.0 52 65.0 295 73.0 To increase the amount of patient education provided 265 81.8 58 72.5 323 80.0 To increase the amount of attention given to secondary problems or symptoms __________________ _ 223 68.9 48 60.0 271 67.1 To assure higher quality of care3 35 10.8 11 13.8 46 11.4 To extend services to more persons (in general) 269 83.0 67 83.8 336 83.2 To increase the number of patients in the practice 127 39.2 32 40.0 159 39.4 To increase physicians’ time for other professional or leisure activity _________________________________ 100 30.9 18 22.5 118 29.2 To provide for patients previously uncared for 164 50.6 37 46.2 201 49.8 To increase the number of home visits provided by the practice _____________________________________ _ 38 11.7 13 16.2 51 12.6 To increase cost effectiveness3 7 2.2 7 1.7 To establish or provide health services, i.e., screening, school health clinic3 ______________________ _. 16 4.9 3 3.8 19 4.7 To experiment with or demonstrate new delivery model3 7 2.2 4 5.0 11 2.7 To cope with existing practice (in general) 81 25.0 21 26.2 102 25.2 To substitute for or assist MD to serve in overburdened practice3 ____________________________________ 19 5.9 4 5.0 23 5.7 To take some of the “on call” load 67 20.7 18 22.5 85 21.0 To serve as a teacher to students and staff3 8 2.5 14 17.5 22 5.4 ‘Categories are not mutually exclusive. 2Nine employers of NPs completing certificate programs and one employer of an NP completing a master’s program did not supply information on reasons for employing the NP. 3This category was developed to accommodate responses to an open-ended item. 11 GISVI-Id mms 031 Table 94.—Employers, by most important reason for employing the NP and type of NP program Type of program Certificate Master’s Total ‘ Most important reason No. Pct. No. Pct. No. Pct. To improve quality of care (in general) 176 55.8 38 48.1 214 54.3 To allow physician(s) to spend more time on complex cases 82 26.0 11 13.9 93 23.6 To increase the amount of patient education provided 39 12.4 10 12.7 49 12.4 To increase the amount of attention given to secondary problems or symptoms ______________________ 24 7.6 9 11.4 33 8.4 To assure higher quality of care2 31 9.8 8 10.1 39 9.9 To extend services to more persons (in general) 121 38.4 27 34.1 148 37.6 To increase the number of patients in the practice 36 11.4 5 6.3 41 10.4 To increase physicians’ time for other professional or leisure activity __ _______________________ 5 1.6 3 3.8 8 2.0 To provide for patients previously uncared for 59 18.7 13 16.4 72 18.3 To increase cost effectiveness2 1.0 3 .8 To establish or provide health services, i.e., screening, school health clinic2 _________________________ 14 4.4 2 2.5 16 4.1 To experiment with or demonstrate new delivery model2 4 1.3 4 5.1 8 2.0 To cope with existing practice (in general) 15 4.8 4 5.1 19 4.8 To substitute for or assist MD to serve in overburdened practice2 _________________________________ _ 11 3.5 4 5.1 15 3.8 To take some of the “on call” load 4 1.3 4 1.0 To serve as a teacher to students and staff2 3 1.0 10 12.7 13 3.3 Total 315 100.0 79 100.0 394 100.0 ‘Eighteen employers of NPS. completing certificate programs and two employers of NPs completing master’s programs did not supply information on the most important reason for employing the NP. 2This category was developed to accommodate responses to an open-ended item. 131 SC-I'ISVJ. Table 95.—Employers, by impressions of the efiect(s) of employing the NP and type of NP program Type of Program Certificate Master’s Total2 N = 328 N = 80 N = 408 Efl'ect(s) of employing NPl No. Pct. No. Pct. No. Pct. Has improved quality of care (in general) 310 94.5 68 85.0 378 92.6 Has allowed physician(s) to spend more time on complex cases 236 72.0 53 66.2 289 70.8 Has increased the amount of patient education provided 279 85.1 62 77.5 341 83.6 Has increased the amount of attention given to secondary problems and symptoms ___________________ 225 68.6 53 66.2 278 68.1 Has assured higher quality of care3 33 10.1 8 10.0 41 10.0 Has extended services to more persons (in general) 273 83.2 66 82.5 339 83.1 Has increased the number of patients in the practice 175 53.4 43 53.8 218 53.4 Has increased physician’s time for other professional or leisure activity ___________________________________ 106 32.3 24 30.0 130 31.9 Has allowed practice to provide for patients previously uncared for _____________________________________ 165 50.3 38 47.5 203 49.8 Has increased the number of home visits provided by the practice ________________________________________ 44 13.4 18 22.5 62 15.2 Has increased cost effectiveness3 4 1.2 4 1.0 Has established or provided health services, i.e., screening, school health clinic3 _______________________ 18 5.5 1 1.2 19 4.7 Has demonstrated new delivery model3 3 .9 2 2.5 5 1.2 Has helped to cope with existing practice (in general) 108 32.9 34 42.5 142 34.8 Has substituted or assisted MD to serve in overburdened practice3 ________________________________________ 16 4.9 3 3.8 19 4.7 Has taken some of the “on call” load 79 24.1 28 35.0 107 26.2 Has served as a teacher to students and staff 3 8 2.4 12 15.0 20 4.9 ‘Categories are not mutually exclusive. 2Five employers of NPs completing certificate programs and one employer of an NP completing a master’s program did not supply information on their impressions of efl'ects of employing the NP. 2This category was developed to accommodate responses to an open—ended item. 11 EISVHd IsClflLS ZZI Table 96.—Employers, by impressions of the most significant effect of employing the NP and type of NP program Type of program Certificate Master’s Total 1 Most significant effect of employing NP No. Pct. No. Pct. No. Pct. Has improved quality of care (in general) 178 55.4 42 53.9 220 55.1 Has allowed physician(s) to spend more time on complex cases 64 19.9 8 10.3 72 18.0 Has increased the amount of patient education provided 51 15.9 15 19.2 66 16.5 Has increased the amount of attention given to secondary problems and symptoms ___________________ 33 10.3 11 14.1 44 11.0 Has assured higher quality of care2 30 9.3 8 10.3 38 9.5 Has extended services to more persons (in general) 123 38.3 22 28.2 145 36.3 Has increased the number of patients in the practice 40 12.4 7 8.9 47 11.8 Has increased physician’s time for other professional or leisure activity ________________________________ 7 2.2 2 2.6 9 2.3 Has allowed practice to provide for patients previously uncared for _______________________________________ 58 18.1 10 12.8 68 17.0 Has increased the number of home visits provided by the practice _________________________________________ 1 .3 1 1.3 2 .5 Has established or provided health services, i.e., screening school health clinic2 ________________________ 15 4.7 15 3.8 Has demonstrated new delivery model2 2 .6 2 2.6 4 1.0 Has helped to cope with existing practice (in general) 15 4.7 4 5.1 19 4.8' Has substituted or assisted MD to serve in overburdened practice2 _______________________________________ 10 3.1 3 3.8 13 3.3 Has taken some of the “on cal ” load 5 1.6 1 1.3 6 1.5 Has served as a teacher to students and staff 2 5 1.6 10 12.8 15 3.8 Total 321 100.0 78 100.0 399 100.0 l'l‘welve employers of NPs completing certificate programs and three employers of NPs completing master’s programs did not supply information on their impressions of the most significant effect of employing the NP. 2This category was developed to accommodate responses to an open-ended item. SEI'IQVL 831 124 STUDY PHASE II Table 97.—Comparison of employers’ most important reason for employing the NP with their impressions of its most significant effect, by type of NP program Type of program Most important Most significant reason effect Selected items Pct. Pct. Certificate (N=308) Improve quality of care ___________________________________ 55.5 55.5 Extend services to more persons ____________________ 38.6 39.0 Cope with existing practice ______________________________ 4.9 4.2 Serve as a teacher to students and stafl’I ____________ 1.0 1.3 Total 100.0 100.0 Master’s (N = 77) Improve quality of care___ ___________________ 48.0 54.5 Extend services to more persons _____________________ 33.8 28.6 Cope with existing practice ___ __________________ 5.2 3.9 Serve as a teacher to students and staffI ____________ 13.0 13.0 Total 100.0 100.0 Total2 (N =385) Improve quality of care ________________________________ 54.0 55.3 Extend services to more persons _____________ _ 37.7 36.9 Cope with existing practice _____________________________ 4.9 4.2 Serve as a teacher to students and staff 1 ___________ 3.4 3.6 Total 100.0 100.0 1This category was developed to accommodate responses to an open-ended item. 2'I‘wenty-iive employers of NPs completing certificate programs and {our employers of NPs completing master's programs did not supply information on the most important reason for employing the NP, the most significant eflect of employing the NP, or both. Table 98.—Employers’ most important reason for employing the NP, by their impressions of the most significant effect and type of NP program Most significant effect (in general) and type of program Has helped Has served Has extended to cope as a teacher Has improved services to with existing to students quality more persons practice and staff1 Total Most important reason (in general) No. No. No. No. No. Certificate To improve quality of care _________________________ 146 18 5 2 171 To extend services to more persons _ 21 98 119 To cope with existing practice _____________________ 4 4 7 15 To serve as a teacher to students and stafi“ __ 1 2 3 Total 171 120 13 4 308 Master’s To improve quality of care ______________________ 30 5 2 37 To extend services to more persons ____________ 11 14 1 26 To cope with existing practice __________________ 2 2 4 To serve as a teacher to students and stafl"1 __ 1 1 8 10 Total 42 22 3 10 77 Total2 To improve quality of care _______________________ 176 23 5 4 208 To extend services to more persons _ ________ 32 112 1 145 To cope with existing practice __________________ _ 4 6 9 19 To serve as a teacher to students and stafl"l ,_ 1 1 1 10 13 Total 213 142 16 14 385 1This category was developed to accommodate responses to an open-ended item. 2Twenty-five employers of NPs completing certificate programs and four employers of NPs completing master’s programs did not supply information on the most important reason for employing the NPs, the most significant effect of employing the NP, or both. 931 smavt Table 99.—Employers, by impressions of changes which occurred in conjunction with the employment of the NP and type of NP program Type of program Certificate Master’s Total2 N=329 N=81 N=410 Change 1 No. Pct. No. Pct. No. Pct. Pattern of flow of patients through the practice 139 42.2 32 39.5 171 41.7 Physical plant of practice setting (remodeling, expansion, relocation) _________________________________________ 70 21.3 19 23.5 89 21.7 Establishment of a relationship with an educational or other institution _____________________--_______________ 69 21.0 16 19.8 85 20.7 Addition of new practice units (e. g., a satellite clinic, new clinic unit) _____________________________________ 67 20.4 18 22.2 85 20.7 Increase in clerical stafi‘ 50 15.2 11 13.6 61 14.9 Extension of “office hours” 43 13.1 12 14.8 55 13.4 Increase in professional staff 39 11.9 12 14.8 51 12.4 Increase in technical staff 22 6.7 8 9.9 30 7.3 Decrease in professional staff 26 7.9 3 3.7 29 7.1 Source of funds 18 5.5 8 9.9 26 6.3 Reduction of “office hours” 14 4.3 3 3.7 17 4.1 Change in type of ownership of the practice setting 6 1.8 3 3.7 9 2.2 Other changes3 9 2.7 3.7 12 2.9 No changes 92 28.0 25 30.9 117 28.5 lCategories are not mutlmlly exclusive. 2Four employers of NPs completing certifimte programs did not supply information on impression of changes which occurred in conjunction with the employment of the NP. 3 Other changes includes positive influence on others outside the practice, increased student education, increased activities resulting in improved quality of care, and decreased technical staff. 11 ssvx-Id Mints 931 TABLES 127 Table 100.—Employers, by whether they felt the benefits derived from the NP outweighed the costs and type of NP program Type of program Certificate Master’s Total1 Benefits No. Pct. No. Pct. No. Pct. Outweighed costs ______________________________ 297 92.0 74 93.7 371 92.3 Did not outweigh costs ______________________ 26 8.0 5 6.3 31 7.7 Total 323 100.0 79 100.0 402 100.0 lTen employers of NPs completing certificate programs and two employers of NPs completing master’s programs did not supply information on whether benefits outweighed costs. Table 101.—Employers,l by reasons they felt benefits derived from the NP did not outweigh costs and type of NP program Type of program Certificate Master’s Total N=26 N=5 N=31 Reason(s) benefits did not outweigh costs2 No. Pct. No. Pct. No. Pct. Time of NP not filled to maximum pro- ductivity ____________________________________ 17 65.4 4 80.0 21 67.7 NP performs skills more slowly than MD 9 34.6 2 40.0 11 35.5 NP offers nonreimbursed services _______ 8 30.8 2 40.0 10 32.3 Salary excessive for level of perform- ance 5 19.2 1 20.0 6 19.4 NP appears to need additional training. 5 19.2 5 16.1 NP’s personality unsuited to role _________ 1 3.8 1 3.2 Other3 ____._____-_____-________-__________________ 1 3.8 2 40.0 3 9.7 1This presentation is based on those employers who felt that benefits did not outweigh the costs. 2Categories are not mutually exclusive. , 3 Other reasons were that the practice had begun too recently to assess the NP's value and confusion over role. 128 STUDY PHASE II Table 102.—Employers,l by impressions of how well various groups accepted the NP role and type of NP program Degree of acceptance and type of program Fairly Well well Not accepted accepted accepted Total Groups No. Pct. No. Pct. No. Pct. No. Pct. Certificate Physician administrators__________-_____ 222 79.6 43 15.4 14 5.0 279 100.0 Nurse administrators (including supervisors) ______________ 189 70.3 59 21.9 21 7.8 269 100.0 Nonclinical administrators ________ __ 195 71.2 74 27.0 5 1.8 274 100.0 Physicians ___________________________________ 195 62.9 104 33.6 11 3.5 310 100.0 RNs (including PHNs, NPs) __________ 180 59.6 110 36.4 12 4.0 302 100.0 Other nursing personnel ________ ___ 175 63.9 91 33.2 8 2.9 274 100.0 Clerical staff ______________________________ 244 78.4 59 19.0 8 2.6 311 100.0 Patients ____________________________________ 285 87.4 41 12.6 326 100.0 People in community____ ____ 211 78.7 57 21.3 268 100.0 Pharmacists _____________________ _____-- 146 65.5 65 29.1 12 5.4 223 100.0 Master’s Physician administrators _______________ 59 85.5 9 13.1 1 1.4 69 100.0 Nurse administrators (including supervisors) _______________ 45 70.3 17 26.6 2 3.1 64 100.0 Nonclinical administrators ___________ 46 70.8 19 29.2 65 100.0 Physicians _______________________________ 47 60.2 30 38.5 1 1.3 78 100.0 RNs (including PHNs, NPs) _______ 52 69.4 22 29.3 1 1.3 75 100.0 Other nursing personnel__-_________-___ 51 74.0 15 21.7 3 4.3 69 100.0 Clerical staff _______________________ 60 78.9 16 21.1 76 100.0 Patients _________________________________ 72 91.1 7 8.9 79 100.0 People in community__ ___________ 55 87.3 8 12.7 63 100.0 Pharmacists_ ____________________________ 33 71.8 11 23.9 2 4.3 46 100.0 Total2 Physician administrators________________ 281 80.8 52 14.9 15 4.3 348 100.0 Nurse administrators (including supervisors) _____________ 234 70.3 76 22.8 23 6.9 333 100.0 Nonclinical administrators____ _______ 241 71.1 93 27.4 5 1.5 339 100.0 Physicians _______________________________ 242 62.4 134 34.5 12 3.1 388 100.0 RNs (including PHNs, NPs)_ _____ 232 61.5 132 35.0 13 3.5 377 100.0 Other nursing personnel _______________ 226 65.9 106 30.9 11 3.2 343 100.0 Clerical stafl’__________, ____________________ 304 78.5 75 19.4 8 2.1 387 100.0 Patients_ ______________________________ 357 88.1 48 11.9 405 100.0 80.4 65 19.6 331 100.0 Pharmacists _______________________________ 179 66.5 76 28.3 14 5.2 269 100.0 1This presentation is based on the number of employers for whom it was applicable and who could rate the NP role in each category. 2Fewer than 28 employers of NPs completing certificate programs and fewer than five employers of N Ps completing master's programs did not supply information on how well various groups accepted the NP role. TABLES 129 Table 103.—NPs,l by impressions of how well various groups accepted the NP role and type of NP program Degree of acceptance and type of program Fairly Well well Not accepted accepted accepted Total Groups No. Pct. No. Pct. No. Pct. No. Pct. Certificate Physician administrators _______________ 245 76.8 63 19.7 11 3.5 319 100.0 Nurse administrators (including supervisors) ____-__________ 203 69.5 74 25.4 15 5.1 292 100.0 Nonclinical administrators __________ ,_ 216 72.7 72 24.2 9 3.1 297 100.0 Physicians __________________________________ 236 63.6 126 34.0 9 2.4 371 100.0 RNs (including PHNs, NPS)_ _______ 230 63.5 121 33.4 11 3.1 362 100.0 Other nursing personnel ________________ 223 66.6 108 32.2 4 1.2 335 100.0 Clerical staff __________________________ 292 78.7 74 20.0 5 1.3 371 100.0 Patients _____ 1 ________________________________ 348 88.8 44 11.2 392 100.0 People in community __________ ._ 235 72.1 91 27.9 326 100.0 Pharmacists_ ___________________________ 162 64.5 74 29.5 15 6.0 251 100.0 Master’s Physician administrators________________ 55 67.1 25 30.5 2 2.4 82 100.0 Nurse administrators (including supervisors) ______________ 46 58.2 27 34.2 6 7.6 79 100.0 Nonclinical administrators__ 41 58.6 28 40.0 1 1.4 70 100.0 Physicians __________________________________ 48 51.6 43 46.2 2 2.2 93 100.0 RNs (including PHNs, NPs) ___________ 55 61.1 34 37.8 1 1.1 90 100.0 Other nursing personnel ______________ 43 50.6 40 47.1 2 2.3 85 100.0 Clerical stafi____ _______________ __ 63 67.7 29 31.2 1 1.1 93 100.0 Patients ____________________________ 85 90.4 9 9.6 94 100.0 People in community _______ 63 76.8 18 22.0 1 1.2 82 100.0 Pharmacists ________________________________ 28 48.3 24 41.4 6 10.3 58 100.0 Total2 Physician administrators__________-_____ 300 74.8 88 22.0 13 3.2 401 100.0 Nurse administrators (including supervisors) ______________ 249 67.1 101 27.2 21 5.7 371 100.0 Nonclinicaladministrators_. ______ _ 257 70.0 100 27.3 10 2.7 367 100.0 Physicians ___________________________ 284 61.2 169 36.4 11 2.4 464 100.0 RNs (including PHNs, NPs) __________ 285 63.1 155 34.3 12 2.6 452 100.0 Other nursing personnel ______________ 266 63.3 148 35.2 6 1.5 420 100.0 Clerical staff_ ___________________________ 355 76.5 103 22.2 6 1.3 464 100.0 Patients ___________________________________ 433 89.1 53 10.9 486 100.0 People in community ________ __ 298 73.0 109 26.7 1 .3 408 100.0 Pharmacists __________________________ 190 61.5 98 31.7 21 6.8 309 100.0 ‘This presentation is based on the number of NPs providing primary care for whom it was applicable and who could rate the NP role in each category. 2Fewer than 28 NPs completing certificate programs and fewer than six NPs completing master’s programs did not supply information on how well various groups accepted the NP role. Table 104.—Ag'reement between NPs and employers‘ in rating the NP role as acceptable2 to various groups, by type of NP program Type of program 11 EISVHd mms 081 Certificate Master‘s Total N P—employer Agreement: N P-employer Agreement: N P-employer Agreement: pairs NP role acceptable pairs NP role acceptable pairs NP role acceptable Groups No. No. Pct. No. No. Pct. No. No. Pct. Physician administrators _______________________ 233 220 94.4 62 59 95.2 295 279 94.6 Nurse administrators (including supervisors) ______________________ 221 202 91.4 56 52 92.9 277 254 91.7 Nonclinical administrators_______________________ 224 216 96.4 49 48 98.0 273 264 96.7 Physicians_ ______________ -_ 291 281 96.6 78 75 96.2 369 356 96.5 RNs (including PHNs, NPs) ____________________ 275 260 94.5 72 70 97.2 347 330 95.1 Other nursing personnel _ _____________________ 242 233 96.3 64 59 92.2 306 292 95.4 Clerical staff _______________________________________ 289 279 96. 5 72 71 98. 6 361 350 97.0 Patients 317 317 100.0 78 78 100.0 395 395 100.0 People in community_ ___________________________ 229 229 100.0 56 55 98.2 285 284 99.6 Pharmacists_ _______________________________ 167 151 90.4 31 27 87. l 198 182 91.9 1This presentation is based on the number of NPs providing primary care and their employers for whom it was applicable and who could rate the NP role in each category. 2Acceptable includes those responses previously listed under well accepted and fairly well accepted. Table 105.—Employers, by impressions of barriers to the NP’s role development and type of NP program Type of program Certificate Masters Total2 N = 327 N = 80 N = 407 Impressions of barriers‘ No. Pct. No. Pct. No. Pct. Legal restrictions 105 32.1 21 26.2 126 31.0 Limitations of space and/or facilities 84 25.7 17 21.2 101 24.8 Resistance from other health providers in the practice 78 23.8 17 21.2 95 23.3 Resistance from health providers outside the practice (including professional organizations, groups, individuals) 71 21.7 11 13.8 82 20.1 Lack of appropriate job classification within the institution or agency _________________________________________ 62 19.0 7 8.8 69 17.0 Too many patients to practice in this role satisfactorily 28 8.6 9 11.2 37 9.1 Lack of confidence/willingness in taking on the responsibilities of the new role ___________________________ 37 11.3 5 6.2 42 10.3 Too few patients to practice in this role satisfactorily 26 8.0 5 6.2 31 7.6 Lack of physician backup3 6 1.8 1 1.2 7 1.7 Interference of non-NP tasks3 4 1.2 5 6.2 9 2.2 Resistance from patients, consumer groups 15 4.6 1 1.2 16 3.9 Lack of opportunity for further professional growth3 1 .3 1 .2 Interpersonal conflicts3 8 2.4 2 2.5 10 2.5 Lack of third party payments and high cost of malpractice insurance3________________________________________ 5 1.5 5 1.2 No barriers 75 22.9 23 28.8 98 24.1 ‘Categories are not mutually exclusive. 2Six employers of NPs completing certificate programs and one employer of an NP completing a master's program did not supply information on b 3'1‘his category was developed to accommodate responses to an openended item. arriers to the NP‘s role development. SE'IflVXL ISI Table 106.—NPs,l by impressions of barriers to their role development and type of NP program Type of program Certificate Master’s Total3 N =400 N =97 N =497 Impressions of barriers2 No. Pct. No. Pct. No. Pct. Legal restrictions 174 43.5 51 52.6 225 45.3 Limitations of space and/or facilities 136 34.0 38 39.2 174 35.0 Resistance from other health providers in the practice 106 26.5 37 38.1 143 28.8 Resistance from health providers outside the practice (including professional organizations, groups, individuals) 108 27.0 27 27.8 135 27.2 Lack of appropriate job classification within the institution or agency ____________________________________ _ 103 25.8 29 29.9 132 26.6 Too many patients to practice in this role satisfactorily 79 19.7 16 16.5 95 19.1 Lack of confidence/willingness in taking on the responsibilities of the new role _________________________ 44 11.0 12 12.4 56 11.3 Too few patients to practice in this role satisfactorily 30 7.5 7 7.2 37 7.4 Practice area available is too far from home 21 5.2 5 5.2 26 5.2 Lack of physician backup4 14 3.5 1 1.0 15 3.0 Interference of non—NP tasks‘a 12 3.0 3 3.1 15 3.0 Resistance from patients, consumer groups 8 2.0 3 3.1 11 2.2 Lack of opportunity for further professional growth4 10 2.5 1 1.0 11 2.2 Lack of third party payments4 4 1.0 4 4.1 8 1.6 Interpersonal conflicts 4 6 1.5 1 1.0 7 1.4 No barriers 44 11.0 9 9.3 53 10.7 ‘NPs for this presentation are those providing primary care. 2Categories are not mutually exclusive. 3'1'hree NPs completing certificate programs did not supply information on barriers to role development. ‘This category was developed to accommodate responses to an open-ended item. 11 EISVHd mass 331 Table 107.—Employers reporting selected barriers to the NP’s role development and NP agreement with this impression, by type of NP program Type of program Certificate Master’s Total No. of Percent of No. of Percent of N0. of Percent of employers NP agreement employers NP agreement employers NP agreement reporting a with this reporting a with this reporting a with this Selected barriersl barrier impression barrier impression barrier impression Legal restrictions _____________ ,. 105 61.9 21 71.4 126 63.5 Limitations of space and/or facili- ties___ _______________ 83 59.0 17 52.9 100 58.0 Resistance from other health providers in the practice _.____-- 77 42.9 17 52.9 94 44.7 Resistance from health providers outside the practice (including professional organizations, groups, individuals) ___________ _ 71 49.3 11 9.1 82 43.9 Lack of appropriate job classifi- cation within the institution or agency ________________________________ 62 56.5 7 57. 1 69 56.5 Lack of confidence/willingness in taking on the responsibilities of the new role _________________________ 37 32.4 5 80.0 42 38.1 Too many patients to practice in this role satisfactorily ____________ 28 60.7 9 55.6 37 59.5 Too few patients to practice in this role satisfactorily __________ _ 26 34.6 5 20.0 31 32.3 Resistance from patients, con- sumer groups __________________ _ 15 1 l6 No barriers 75 22.7 23 13.0 98 20.4 ‘Categories. are not mutually exclusive. 881 smau 134 STUDY PHASE II Table 108.—NPs,l by their degree of general satisfaction with their present positions and type of NP program Type of program N Ps’ degree of Certificate Master's Total2 general satisfaction No. Pct. No. Pct. No. Pct. Very satisfied __________________________________ 261 65.6 51 52.6 312 63.1 Somewhat satisfied ____________________________ 109 27.4 33 34.0 142 28.7 Neutral ______-________-___, __- 8 2.0 3 3.1 11 2.2 Somewhat dissatisfied ________________________ 15 3.8 9 9.3 24 4.8 Very dissatisfied _______________________________ 5 1.2 1 1.0 6 1.2 Total 398 100.0 97 100.0 495 100.0 lNPs for this presentation are those providing primary care. 2Five NPs completing certificate programs did not supply information on their degree of general satisfaction with their present positions. Table 109.-—NPs,‘ by their degree of satisfaction with specific aspects of their present positions and type of NP program NPs’ degree of satisfaction and type of program Very Somewhat Somewhat Very satisfied satisfied Neutral dissatisfied dissatisfied Total Specific aspects of position No. Pct. No. Pct. No. Pct. No. Pct. N0. Pct. No. Pct. Certificate Type of patients served -,-________- 267 66.9 99 24.8 19 4.8 13 3.3 1 .2 399 100.0 Pay and benefits ______________________ 104 26.2 137 34.5 37 9.3 87 21.9 32 8.1 397 100.0 Administrative climate within setting ________________________________ 119 30.1 105 26.5 44 11.1 97 24.5 31 7.8 396 100.0 Location of job ________________________ 235 59.0 69 17.3 40 10.1 43 10.8 11 2.8 398 100.0 Variety of activities required _____ 209 52.5 111 27.9 28 7.0 44 11.1 6 1.5 398 100.0 Emotional demands of job _________ 155 38.8 126 31.6 53 13.3 55 13.8 10 2.5 399 100.0 Proportion of time spent on non- professional tasks _________ 128 32.1 87 21.8 69 17.3 87 21.8 28 7.0 399 100.0 Amount of work required__ 190 47.7 108 27.1 53 13.3 40 10.1 7 1.8 398 100.0 Availability of facilities ____________ 169 42.4 117 29.3 40 10.0 53 13.3 20 5.0 399 100.0 Backup necessary to provide good patient care ____________________ 196 49.4 93 23.4 25 6.3 65 16.4 18 4.5 397 100.0 Preparation for the tasks as- signed ________________________ 190 47.6 158 39.6 17 4.3 28 7.0 6 1.5 399 100.0 Type of assignment (level accord- ing to abilities) __ ______________ 229 57.5 113 28.4 17 4.3 32 8.0 7 1.8 398 100.0 General satisfaction with work as an NP __________________________ 261 65.6 109 27.4 8 2.0 15 3.8 5 1.2 398 100.0 See footnote at end of table. SEI'IHVL QSI Table 109,—NPs,1 by their degree of satisfaction with specific aspects of their present positions and type of NP program—continued NPs’ degree of satisfaction and type of program Very Somewhat Somewhat Very satisfied satisfied Neutral dissatisfied dissatisfied Total Specific aspects of position No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Master’s Type of patients served ___________ 50 51.5 36 37.1 5 5.2 6 6.2 97 100.0 Pay and benefits” _______ _ 32 33.0 28 28.9 9 9.3 20 20.6 8 8.2 97 100.0 Administrative climate within setting ______ _____ _ 20 21.1 25 26.3 10 10.5 28 29.5 12 12.6 95 100.0 Location of job__._.___ _______ 44 45.3 26 26.8 13 13.4 12 12.4 2 2.1 97 100.0 Variety of activities required ___ 47 48.4 31 32.0 5 5.2 11 11.3 3 3.1 97 100.0 Emotional demands of job ________ 25 25.8 29 29.9 16 16.5 19 19.6 8 8.2 97 100.0 Proportion of time spent on non- professional tasks ______________ 24 25.0 27 28.1 16 16.7 19 19.8 10 10.4 96 100.0 Amount of work required ________ 27 28.1 38 39.6 14 14.6 16 16.7 1 1.0 96 100.0 Availability of facilities ____________ 27 27.8 27 27.8 16 16.5 21 21.7 6 6.2 97 100.0 Backup necessary to provide good patient care _ _______________________ 45 46.3 21 21.7 7 7.2 21 21.7 3 3.1 97 100.0 Preparation for the tasks as- signed ______________________________ 38 39.2 43 44.3 4 4.1 10 10.3 2 2.1 97 100.0 Type of assignment (level accord- ing to abilities) ________________ _ 47 49.0 27 28.1 7 7.3 12 12.5 3 3.1 96 100.0 General satisfaction with work as an NP _____________________________ 51 52.6 33 34.0 3 3.1 9 9.3 1 1.0 97 100.0 981 II HSVHJ ROMS Type of patients served ____________ Pay and benefits ________________ Administrative climate within setting _. _________________________ Location of job ___________________ _ Variety of activities required ..___ Emotional demands of job _________ Proportion of time spent on non- professional tasks .............. Amount of work required ......... Availability of facilities _____________ Backup necessary to provide good patient care ________________________ Preparation for the tasks as- signed_ __________________________ Type of assignment (level accord- ing to abilities) _______________ _ General satisfaction with work as an NP ____________________________ 317 136 139 279 180 152 217 196 241 228 276 312 64.0 27.5 28.3 56.4 51.7 36.3 30.7 43.9 39.5 48.8 46.0 55.9 63.0 135 165 130 95 142 155 114 146 144 1 14 201 140 142 27.2 33.4 26.5 19.2 28.7 31.3 23.0 29.6 29.1 23.1 40.5 28.3 28.7 46 33 69 67 56 32 21 11 4.8 9.3 11.0 10.7 6.7 13.9 17.2 13.6 11.3 6.5 4.2 4.9 2.2 Total2 19 107 125 3.8 21.7 25.4 11.1 11.1 14.9 21.4 11.3 14.9 17.4 7.7 8.9 4.9 40 13 18 26 21 10 8.8 2.6 1.8 3.6 7.7 1.6 5.2 4.2 1.6 2.0 1.2 496 494 491 495 495 496 495 494 496 494 496 494 495 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 ‘NPs for this presentation are those providing primary care. 2Fewer than eight NPs completing certificate programs and fewer than three NPs completing master‘s programs did not supply information on their degree of satisfaction for each specific aspect of their present positions. SH'IHVL L81 Table 110.—NPsl employed full time, by their degree of general satisfaction with their present positions, by gross, annual, nursing income, and type of NP program Income (in thousands of dollars) and type of program 6—10 11—15 16—20 >20 Total NPs’ degree of general satisfaction No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Very satisfied 25 62.5 148 64.6 37 67.3 5 100.0 215 65.3 Somewhat satisfied 11 27.5 65 28.4 15 27.3 91 27.7 Neutral 3 7.5 2 0.9 2 3.6 7 2.1 Somewhat dissatisfied __________________________________________ 1 2.5 13 5.7 1 1.8 15 4.6 Very dissatisfied 1 0.4 1 0.3 Total 40 100.0 229 100.0 55 100.0 5 100.0 329 100.0 Master’s Very satisfied « -- 25 47.1 17 54.9 -- -- 42 50.0 Somewhat satisfied -- -- 18 34.0 12 38.7 —- -- 30 35.7 Neutral -- -- 2 3.8 ... ... -- -- 2 2.4 Somewhat dissatisfied________,________--______________________- -- -- 8 15.1 1 3.2 -- -— 9 10.7 Very dissatisfied —- -- 1 3.2 -- -— 1 1.2 Total -- -- 53 100.0 31 100.0 -- -- 84 100.0 II ESVHcl AGILLS 881 Very satisfied 25 Somewhat satisfied 1] Neutral 3 Somewhat dissatisfied ________________________________________ 1 Very dissatisfied Total 40 62.5 27.5 7.5 2.5 100.0 61.4 29.4 1.4 7.4 0.4 100.0 Total2 54 62.8 27 31.4 2 2.3 2 2.3 1 1.2 86 100.0 5 100.0 5 100.0 257 121 24 413 62.2 29.3 2.2 5.8 0.5 100.0 ‘NPs for this presentation are those providing primary care. 2Two N Ps completing certificate programs worked voluntarily without compensation. Fifteen NPs completing certificate programs and two NPs completing master's programs did not supply information on their degree of general satisfaction with their present positions, income, or both. SEI’IEIVL 681 140 STUDY PHASE II Table 111.-—Employers, by their degree of general satisfaction with the NP and type of NP program Type of program Employers’ degree Certificate Master’s Total1 of general satisfaction No. Pct. No. Pct. No Pct Very satisfied __________________________________ 276 84.2 73 90.1 349 85 3 Somewhat satisfied ____________________________ 45 13.7 5 6.2 50 12.2 Neutral ___________________ 3 0.9 3 3.7 6 1.5 Somewhat dissatisfied--- 4 1.2 4 1.0 Very dissatisfied ----------------------------- Total 328 100.0 81 100.0 409 100.0 ‘Five employers of NPs completing certificate programs did not supply information on their degree of general satisfaction with the NP. Table ll2.—Employers, by their degree of satisfaction with the NP’s functioning and type of NP program Employers’ degree of satisfaction and type of program Very Somewhat Somewhat Very Satisfied Satisfied N eutrai Dissatisfied Dissatisfied Total NP’s functioning Pct. Pct. Pct. Pct. Pct. Pct. No. Certificate Integration of NP’s role with the roles of others in the practice setting __________________________ 77.4 17.3 2.8 2.5 100.0 324 Competency in carrying out new NP functions _______________ .. 86.3 11.6 .9 1.2 100.0 328 Adequacy of NP’s productivity (relationship between fiscal cost/benefits she provides) _____ 61.2 23.1 11.6 4.1 100.0 320 Type of patients NP is caring for __________________________ 77.8 18.1 3.1 1.0 100.0 320 Number of patients NP is caring for ___________________________________ 63.4 25.9 6.4 4.3 100.0 328 General satisfaction ________________ 84.2 13.7 .9 1.2 .. . 100.0 328 Master’s Integration of NP’s role with the roles of others in the practice setting __ __________________________ 80.0 17.5 2.5 100.0 80 Competency in carrying out new NP functions____________ 86.3 12.5 1.2 100.0 80 Adequacy of NP’s productivity (relationship between fiscal cost/benefits she provides) ______ 59.7 22.1 13.0 5.2 100.0 77 SEl'lflVl U71 Table 112.—Employers, by their degree of satisfaction with the NP’s functioning and type of NP program—continued Employers’ degree of satisfaction and type of program Very Somewhat Somewhat Very Satisfied Satisfied Neutral Dissatisfied Dissatisfied Total NP’s functioning Pct. Pct. Pct. Pct. Pct. Pct. No. Type of patients NP is caring for ______________________________________ 86.3 10.0 2.5 1.2 100.0 80 Number of patients NP is caring for ______________________________________ 61.7 27.2 9.9 1.2 100.0 81 General satisfaction _________________ 90.1 6.2 3. 7 100.0 81 Total1 Integration of N P’s role with the roles of others in the practice setting _______________________________ 78.0 17.3 2.2 2.5 100.0 404 Competency in carrying out new NP functions__ ____________ 86.3 11.7 1.0 1.0 100.0 408 Adequacy of NP’s productivity (relationship between fiscal cost/benefits she provides) ______ 61.0 22.9 11.8 4.3 100.0 397 Type of patients NP is caring for ____________________________________ 79.5 16.5 3.0 1.0 100.0 400 Number of patients NP is caring for ______________________________________ 63.1 26.1 7.1 3.7 100.0 409 General satisfaction __________________ 85.3 12.2 1.5 1.0 100.0 409 ' Fewer than 14 employers of N Ps completing certificate programs and fewer than five employers of NPs completing master‘s programs did not supply information on their degree of satisfaction with the NP’s functioning. II EISVHd [\(IILLS ZVI Table ll3.—Employers, by their degree of general satisfaction with the NP, the NP’s prior nursing preparation, and type of NP program Prior nursing preparation and type of program Hospital Associate Baccalaureate Master’s Employers’ degree diploma degree degree degree Total of general . satisfaction No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Very satisfied 140 84.9 13 72.2 109 86.5 14 73.6 276 84.2 Somewhat satisfied 22 13. 3 5 27.8 15 11.9 3 15.8 45 13.7 Neutral 1 .6 1 .8 1 5.3 3 .9 Somewhat dissatisfied_________________________________________ 2 1.2 1 .8 1 5.3 4 1.2 Very dissatisfied Total 165 100.0 18 100.0 126 100.0 19 100.0 328 100.0 Master’s Very satisfied 3 100.0 —- -- 69 89.6 1 100.0 73 90.1 Somewhat satisfied -- -- 5 6.5 5 6.2 Neutral -- -- 3 3.9 3 3.7 Somewhat dissatisfied __________________________________________ —- -- Very dissatisfied -- -- Total 3 100.0 —~ -- 77 100.0 1 100.0 81 100.0 Total1 Very satisfied 143 85.1 13 72.2 178 87.6 15 75.0 349 85.3 Somewhat satisfied 22 13.1 5 27.8 20 9.9 3 15.0 50 12.2 Neutral 1 .6 4 2.0 1 5.0 6 1.5 Somewhat dissatisfied__ ________________________________________ 2 1.2 l .5 1 5.0 4 1.0 Very dissatisfied Total 168 100.0 18 100.0 203 100.0 20 100.0 409 100.0 lFive employers of NPs completing certificate programs did not supply information on their degree of general satisfaction with the NP. SETSVJ. 8171 Table ll4.—Employers, by their degree of general satisfaction with the NP and length and type of NP program Length (in months) and type of program 3—5 6—11 12—17 >18 Total Employers’ degree of general satisfaction No. Pct. No. Pct. No. Pct. No. Pct. No. Pct. Certificate Very satisfied 80 83.4 109 85.8 69 82.1 18 85.7 276 84.2 Somewhat satisfied 14 14.6 16 12.6 12 14.3 3 14.3 45 13.7 Neutral 1 1.0 2 1.6 3 0.9 Somewhat dissatisfied _________________________________________ 1 1.0 3 3.6 4 1.2 Very dissatisfied Total 96 100.0 127 100.0 84 100.0 21 100.0 328 100.0 Master’s Very satisfied 5 100.0 39 95.2 29 82.9 73 90.1 Somewhat satisfied 1 2.4 4 11.4 5 6.2 Neutral 1 2.4 2 5.7 3 3.7 Somewhat dissatisfied _________________________________ Very dissatisfied Total 5 100.0 41 100.0 35, 9100.0 81 100.0 Total1 Very satisfied 80 83.4 114 86.4 108 86.4 47 83.9 349 85.3 Somewhat satisfied 14 14.6 16 12.1 13 10.4 7 12.5 50 12.2 Neutral 1 1.0 2 1.5 1 0.8 2 3.6 6 1.5 Somewhat dissatisfied _________________________________________ 1 1.0 3 2.4 4 1.0 Very dissatisfied Total 96 100.0 132 100.0 125 100.0 56 100.0 409 100.0 lFive employers of NPs completing certificate programs did not supply information on their degree of general satisfaction with the NP. II asvx-ia moms WI Iable ll5.—Employers’ degree of general satisfaction, by NP’s degree of general satisfaction and type of NP program NP’s degree of general satisfaction and type of program Employers’ degree of Very Somewhat Somewhat general satisfaction satisfied satisfied Neutral dissatisfied Total Certificate Very satisfied _________________ 188 70 3 9 272 Somewhat satisfied_____ ______ 29 13 3 45 Neutral ____________________________ 1 2 3 Somewhat dissatisfied _____ 2 1 1 4 Very dissatisfied _____________________ Total_ ______________________ _ 220 86 3 13 324 Master’s Very satisfied __________________ _ 38 25 3 6 73 Somewhat satisfied ________________ 2 3 5 Neutral ____ _________ _______ 1 1 1 3 Somewhat dissatisfied-_ ----- Very dissatisfied _____________ Total __________________________________ 41 29 3 7 81 Total1 Very satisfied __________________________ 226 95 6 15 345 Somewhat satisfied _____________ _ 31 16 3 50 Neutral _______ _________________ 2 3 1 6 Somewhat dissatisfied_ _____ 2 1 1 4 Very dissatisfied _______ _ Total____ _______________ 261 115 6 20 405 lNine employers of NPs or the NPs completing certificate programs did not supply information on degree of satisfaction. gfl sansw. Table 116.——Average job satisfaction-of NPsl as exemplified by attainment, aspiration, and importance with respect to specific job characteristics, by type of NP program Job satisfaction variables3 and type of program Prior nursing position Expectation Present NP position Job characteristics2 Attainment Aspiration Importance Attainment Attainment Aspiration Importance Certificate Planning and organizing your own work routine __________________________ 4.9 5.8 6.2 6.0 5.4 6.1 6.2 Using your own initiative __________ _ 5.2 6.2 6.4 6.4 6.1 6.5 6.5 Freedom in your nursing position____ 4.9 5.8 6.2 6.0 5.8 6.2 6.3 Using independent thought and ac- tion _____________________________________ _ 4.9 6.0 6.4 6.2 6.0 6.4 6.5 Participating in the setting of goals_ 4.6 6.1 6.3 6.2 5.6 6.5 6.4 Participating in the decision-making process ____________________________ 4.4 5.9 6.3 6.0 5.3 6.3 6.4 Participating in determining meth- ods and procedures ____________________ 4.3 5.8 6.0 5.9 5.3 6.2 6.2 Authority connected with your posi- tion__ _________________________ 4.5 5.5 5.8 5.7 5.1 5.9 5.8 Utilizing NP training, preparation, and abilities ___________________________ -- -- -- -- 5.9 6.7 6.7 Overall average ____________________________ 4.7 5.9 6.2 6.0 5.7 6.3 6.4 Standard deviation ___________________ 1.4 .8 .7 .8 1.1 .6 .7 II HSVHd AGOLS QVI Planning and organizing your own work routine___--_-_________-________--_ Using your own initiative ______________ Freedom in your nursing position---- Using independent thought and ac— tion _______________________________________ Participating in the setting of goals- Participating in the decision—making process _________________________________ Participating in determining meth- ods and procedures _________________ AutErity connected with your posi— tion ________________________________________ Utilizing NP training, preparation, and abilities ______________________________ Overall average _____ Standard deviation _______________________ Planning and organizing your own work routine _____________________________ Using your own initiative ______________ Freedom in your nursing position____ Using independent thought and ac- tion ____________________________________ Participating in the setting of goals- See footnotes at end of table. 4.3 4.5 4.1 4.4 4.0 3.8 3.7 4.8 5.0 4.7 4.8 4.5 5.6 6.1 5.6 6.0 6.0 5.8 5.6 5.4 5.8 5.8 6.2 5.7 6.0 6.0 6.2 6.5 6.3 6.5 6.4 6.4 6.0 5.7 6.3 6.2 6.5 6.2 6.4 6.3 Master’s 5.9 6.4 6.0 6.3 6.2 6.1 5.8 5.6 6.0 Total‘ 6.0 6.4 6.0 6.2 6.2 5.3 5.9 5.7 5.8 5.4 5.2 5.2 4.9 5.7 5.4 1.3 5.4 6.1 5.8 6.0 5.6 6.2 6.5 6.4 6.5 6.5 6.4 6.2 6.0 6.6 6.4 6.1 6.5 6.2 6.4 6.5 6.2 6.6 6.4 6.6 6.5 6.4 6.1 5.9 6.7 6.4 6.2 6.5 6.3 6.5 6.4 SEI’IEIVL L171 148 STUDY PHASE II due—«Luca $.3de wig—mace mmZ am can 33.595 SSEfig mzflwano £2 3 an $023.5 :2qu85 so “Em—BE 523:3va m2“ 3;: 0m .zofloémzwm new .5 5.35.35 ban—.5 go: EU SE; @533: mcsflqfiou mn—Z 3 can in 3.85953 ”Ego—AER. wmz EMWJAGEE w .AE=E_§EV h 8 AEEEEEV fl EPG Bug» mosmiofiflnwfi 559833 com 305 0.530.: 8 com: 2.3m BE.“ .hemmugib 35m c533 :Qdm {wag—om .0 EoE< 3 Ecmmmwv 2355383. 5 Spa 5x3 0.3 83mt§u ac“ we." .28 3.3.5.5 MEEZEQ $05 93 553:305 35 .5“ me. b. w. NA w. b. w. ma 8535c gwgm v6 m6 ad o6 Nd m.m we I: low—20>“ 5295 he he 3. -- -- -- -- ||i..----l.ll 855% v5 dosfifica .mcewg m2 “33:5 Wm m6 fim Nam Nam m6 «iv .Ii. ............... lcowfim .om use» 5E ‘cwaowcnsoo hawking» Nd Nd m6. m.m 9w Wm N6 ....... mngoca 98 £5 -52: mcigng E wcmuamomfiwm v .w m .w m. .m o .w m .w a .m m .v IEESIIIIIIIII- wwoooun MchEéommew 23 E mnmuwmmomgm waganH :omumhnmlw ucwfifififiw azwzfigfiw wondfiOQEH :ofimbmmaw 325633» «musmtwagsu non gamma m2 “:3qu 5538me 5?on MEWS: SE 53th no 253 «EN mmmistg 5033353 new 35:55.9'58: #2 «a 093 .3 final .3 :cmuoamwmeam a... wuio>GRA FEVER RHINORRHEA.‘ 16) Obtain or update health history I7) Perform physical exam was x: 18) Order appropriate lab teiflaniL ailostic pro- cedures ‘ ' 19) Decide whether to manage patNMibr refer patient to MD for management 20) Assume health care management of uncomplicated URI FOR CHILDREN WITH BRONCHIAL ASTHMA HA VING A MILD ASTHMA A TTACK: 21) Obtain or update health history 22) Perform physical exam 23) Order appropriate lab tests or diagnostic procedures 24) Decide whether to manage patient or refer patient to MD for management 25) Assume health care management it only oral bron- chodilators were indicated 26) Assume health care management if epinephrine were indicated APPENDIX A 163 IS ADULT HEALTH CARE (EXCLUDING MATERNITY CARE OR FAMILY PLANNING) INCLUDED IN YOUR RESPONSIBILITIES? E] Yes Please complete items 27—85 below D No Please omit items 27-85 and proceed to Section C, page’lS QM! W What Percent of Patients, For 00 You Perform Wham You Perform 777i: Activity, This NP Activity? Do You Consult With A Physician? NP ACTIVITY Yes 0-596 6-2596 26-50% 51-75% No 27) Decide whether patient is essentially well or has a potential problem FOR ESSENTIALLY WELL ADULTS: 28) Obtain or update social/family history 29) Obtain or update health history 30) Obtain routine blood and urine samples 31) a) Perform partial physical exam b) Perform partial mental status exam 32) a) Perform complete physical exam b) Perform complete mental status exam 33) Initiate prevention-oriented teachi selling iii in IF POTENTIAL PROBLEM IS [DEM ‘ ii“ 34) Refer patient automatically to 35) Obtain or update health history 36) Perform physical exam 37) Order specific lab tests or diagnostic promdures 38) Decide whether to manage patient or refer patient to MD for management 39) Assume health care management 40) Initiate problem-oriented teaching and counselling FOR PA T/ENTS WITH PRIMARY COMPLAINT OF NASAL CONGESTION AND RHINORRHEA: 41) Obtain or update health history 42) Perform physical exam 43) Order appropriate lab tests or diagnostic procedures 44) Decide whether to manage patient or refer patient to MD for management 45) Assume health care management (including ini- tiation of oral decongestants for uncomplicated URI) 164 STUDY PHASE II BEMINDER: ANSWER ALL QUESTIONS SELECTED IN QUESTION 9L BEGINNING WITH #10 IN RELATION TO THE PRACTICE SETTING YOU 18. Continued NP ACTIVITY FOR PA TIENTS WITH PHIMAHY COMPLAINT 0F CHEST PA IN: 45) 47) 48) 49) Obtain or update health history Perform physical exam Order appropriate lab tests or diagnostic procedures Decide whether to manage patient or refer patient to MD for management 50) Assume health care management Ior conditions such as musculuskeletal pain FOR PATIENTS WITH PRIMARY COMPLAINT 0F LACERA T/ON.’ 51) Cleanse the wound ' . %Wl i 52) Assess whether there IS tendon/hen “imam“ A w 53) Apply sutures when indicated 7- ‘ Fan ASYMPTOMA TIC FA TIE ‘ A HYPER TENSION: ml) ) ' 54) Obtain or update health histommu 55) 56) 57) Perform physical exam Order appropriate lab tests Decide whether to manage patient or refer to MD for management 58) 59) Assummhealth care management Initiate teaching and counselling (diet, medica- tions, exercise. rest, work) 60) 6|) 62) Alter diet Altar dosage of antihvpertensive drugs Add or delete antihypertensive drugs Do You Perform This NP Activity? Yes M W What Percent of Patients, For Mom You Perform This Activity, 00 You Consult With A Physician? No 51 - 0-596 525% APPENDIX A 165 Continutd 0.95M W What Percent of Patients, For Do You Perform Wham You Perform This Activity, This NP Activity? 00 You Consult With A Physician? NP ACTIVITY Yes No 0-596 6-2556 26-50% 51- FOR SYMPTOMA TIC PA TIENTS WITH HYPE )7 TE NSION: 63) Obtain or update health history 64) Perform physical exam 65) Order appropriate lab tests 66) Decide whether to manage patient or refer to MD for management 67) Assume health care management 68) Initiate teaching and counselling (diet, medications, exercise, rest. work) 69) Alter diet 70) Alter dosage of antihypertensive drugs 71) Add or delete antihypertensive drugs FOR DIABETIC PA TIENTS STABILIZED 0N INSULIN THERAPY: 72) 73) 74) 75) 76) 77) 78) F0}? PATIENTS 0N ORAL HYPOGL YCEMIC AGENTS: 79) 80) 81) 82) 83) 84) 85) Obtain or update health history Pertorm partial physical exam Order appropriaua lab tests or agréfi Maura Decide whether to manage pa :tfi or for patient to MD for management Initiate teaching and counselling related to medi- cation Alter diet Alter dosage of insulin Obtain or update health history Perform physical exam Order appropriate lab tests Decide whether to manage patient or refer patient to MD for management Alter diet Alter dosage of oral hypoglycemic agent Change from oral drugs to insulin 166 STUDY PHASE II REMINDER: ANSWER ALL QUESTIONS BEGINNING WITH #10 IN RELATION TO THE PRACTICE SETTING YOU SELECTED IN QUESTION 9a. C. IS MATERNITY CARE 0R FAMILY PLANNING INCLUDED IN YOUR RESPONSIBILITIES? D Yes Please complete items 86-109 below I: No Please omit items 86-109 and proceed to question 19, page 17 COLUMN | COLUMN ll What Percent of Patients, For Do You Perform Wham You Perform This Activity, This NP Activity? Do You Consult With A Physician? NP ACTIVITV Yes No 0-5% 6-2596 26-50% 51- 86) Decide whether patient is pregnant ,! FOR MA TE RNITY PA T/ENTS: 87) Obtain or update social/family history 88) Obtain or update health history 89) Perform initial physical exam 90) Perform initial pelvic exam including measurern ‘ 91) Perform 2nd trimester checkup incluifijrfe heart sounds and measurement of fu 92) Perform 2nd trimester pelvic exam 93) Perform 3rd trimester chegtup? , ng fetal heart sounds, measurement WuMdur position of baby and engagement of presenq‘a; ‘ 94) Perform 3rd trimester pelvic exam 95) Perform postpartum checkup 96) Perform postpartum pelvic exam 97) Order laboratory work at the appropriate intervals (serolOQY, antibody screening, hematocrit, uri- nalysis) 98) Initiate health teaching and counselling 18. Continued NP ACTIVITY FOR PA TIENTS WITH SYMPTOMA TIC COMPLAINTS: (e.y., nausea; constipation; dysuria, frequency; vaginal discharge wim itching and/or burning; URI; headaches} 99) Decide whether to manage patient or refer patient to MD for management 100) Assume health care management FOR PA TIENTS WITH SE VEHE SYMPTOMA TIC COMPLAINTS: Ie.g.,bleediny; eclampsia; hyperemesis) 101) Decide whether to manage patient or refer patient to MD for management 102) Assume health care management FOR FAM/L Y PLANNING SERVICE: 103) Obtain or update social/family history 104) Obtain or update health history inclu history and past experience with can 105) Perform general physical exam 106) Perform pelvic and obtain s IF NO ABNORMAL/TIES: o smear 107) Initiate teaching and counselling r‘ oeption 108) Place patient on oral contraceptives 109) Insert IUD APPENDIX A 167 COLUMN I COLUMN ll What Percent of Patients, For Do You Perform Whom You Perform This Activity, This NP Activity? Do You Consult With A Physician? Yes No arding contra- 16 168 STUDY PHASE II m: ANSWER ALL QUESTIONS BEGINNING WITH #10 IN RELATION TO THE PRACTICE SETTING VOU SELECTED IN QUESTION 9:. 19. How often is a physician available to you to discuss individual patient problems as they occur? Physician When Not Physically Present, Physically Physicien A val/able Present by Phone always I: [I usu ally D E] sometimes E El seldom E] [I never l: Cl 20. How often does a physician or nurse preoeptor review your records or discuss patients you have cared for? Please check (X) only 93 answer. CI always D usually [3 sometimes Ci seldom D never 21. Do you have clinical supervision for your NP activities C] yes [:1 no If m, by what type of personnel? Cl nUrse practitioner D other RN Cl physician assistant D other (specify) HMMWH“ E .llll fl ( Hill ll , , El 22. To what extent is your new NP rfilfied by each of the following persons or groups in this practice setting? Check Lug response for each category of personwow. NP Role Negative Don't Know/ NP Hale Well Fairly Well Reqmnse Does Not Persons Accepted Accepted to NP Role Apply Physician Administrators Nurse Administrators (including supervisors) Nonclinical Administrators Physicians RNs (including PHNs, NPs) Other Nursing Personnel Clerical Staff Patien ts People in Community Pharmacists APPENDIX A 169 For eadi item below. please circle the number that best represents your assessment of the NP position you are holding now. MINIMUM MAXIMUM M M I) The opportunity for planning and organizing your own work routine. a. How much' Is there‘ In your present NP position? I 2 3 4 5 6 7 b. How much should there be in such a position? I 2 3 4 5 6 7 c. How important is this to you? I 2 3 4 5 6 7 2) The on-the-job freedom in your nursing position. a. How much is there in your present NP position? 1 2 3 4 5 6 7 b. How much should there be in such a position? I 2 3 4 5 6 7 c. How important is this to you? 1 2 3 4 5 6 7 3) The opportunity to use your own initiative. a. How much is there in your present NP position? I 3 4 5 6 7 b. How much should there be in such a position? I ifE 3 4 5 6 7 c. How important is this to you? mwwii 3 4 5 6 7 4) The opportunity for Participating in the setting of goals. :EE. MW a. How much is there in your present NP position? ‘I 2 3 4 5 6 7 b. How much should there be In such a position: ‘ 2 3 4 5 6 7 c. How important is this to you? M M ’i 2 3 4 5 6 7 b 5) The opportunity to participate in the decisioflm MI W process. a How much' Is therein your prese 1 2 3 4 5 6 7 b. How much should there be In such“ 1 2 3 4 5 6 7 c. How important is this to I ”1W 1 2 3 4 5 6 7 mm L!“ i ii 6) The opportunity for participatian). Effimining methods and procedures. $5 a. How much is there in your present NP position? ‘I 2 3 4 5 6 7 b. How much should there be in such e position? 1 2 3 4 5 6 7 c. How important is this to you? 1 2 3 4 5 6 7 7) The opportunity for independent thought and action. a. How much is there in your present NP position? 1 2 3 4 5 6 7 b. How much should there be in such a position? 1 2 3 4 5 6 7 c. How important is this to you? 1 2 3 4 5 6 7 8) The authority connected with your position. a. How much is there in your present NP position? 1 2 3 4 5 6 7 b. How much should there be in such a position? I 2 3 4 5 6 7 c. How important is this to you? 1 2 3 4 5 6 7 9) The opportunity for utilizing NP training, preparation, and abilities. a. How much is there in your present NP position? 1 2 3 4 5 6 7 b. How much should there be in such a position? I 2 3 4 5 6 7 c. How important is this to you? 1 2 3 4 5 6 7 170 STUDY PHASE II 24. In general, how satisfied are you with each of the following aspects of your present NP position? Circle one number for each aspect below. Neither Very Somewhat Satisfied nor Somewhat Very ,. .,. ,. .,. r" "ied r" .'.w r- .. i1) (2) (3) (4) (5) a. type of patients served 1 2 3 4 5 I). pay and benefits 1 2 3 4 5 c. administrative climate within setting 1 2 3 4 5 d. location of job 1 2 3 4 5 g a. variety of activities required 1 2 3 4 5 f. emotional demands ofiob “ 1 3 4 5 “will“: 9. proportion of your time spent on nonprofessional tasks 3 4 5 “- ) h. amount of work required 3 4 5 ' i. availability of facilities 3 4 5 j. backup necessary to provide good patien care 2 3 4 5 k your preparation for the tasks you 1 2 3 4 5 l. the type of assignment you ha to your abilities) 1 2 3 4 5 in. taking all things into consideration, how satisfied are you with your work as an NP 1 2 3 4 5 i 25. APPENDIX A 171 What are the barriers to practice you feel are influencing your NP role development? Check all that apply. ' lack of confidence/willingness in taking on the responsibilities of the new role legal restrictions resistance from other health providers in the practice resistance from health providers outside the practice (including professional organizations, groups, as well as individuals) resistance from patients. consumer groups too fin patients to practice in this role satisfactorily too my patients to practim in this role satisfactorily lack of appropriate iob classification wimin your institution or agency limitations of space and/or facilities practice area available is too far from home other barriers (specify) DDDDDDDUUDD B does not apply - no barriers As a graduate of a nurse practitioner program, please evaluate your program on how well it prepared you for your new role. Please check (m for each area below. Tao Not Covered Areas of Learning Adequate Little in My Program a. conducting a complete physical assessment (exam) D I: [:1 D b. taking a complete health history I: C) I: E] c. performing technical aspects at practice (such as eye grounds. palpating a liver) C) D D I: d. interpreting the results of screening tests C) I: C) [:I e. counselling and teaching E) D E] D f. management of illness [:1 C) U [:1 9. management of behavioral or so D Cl 1: [1 Selected Issues , a. pertinent issues in redefinition of resin: C) D U D b. rcle bargaining on the iob D D I: [:1 c. acquaintance with professional organizations concerned with practice in an expanded role Cl 1:) C) D Were there other areas in which you needed additional preparation or that you did not consider adequate? Please specify areas as clearly as possible. 172 STUDY PHASE II 27. In the following question we are distinguishing between two components of many nurse practitioner programs: A. The DIDACTIC or formal portion in which a specified curriculum is taught using lectures, sell-instruction materials, ene- ooncurrent relevant clinical observations and experiences. 5. The INTERNSHIP or PRECEPTORSHIP portion which is a specified period of supervised clinical practice in patient assessment and management and is a requirement for completion of the program. This is distinct from and follows the clinical experience offered concurrently with the didactic portion. 0n the basis of your training and experience, the ideal length of each component of your program should be: Didactic portion __ months lnternship/Preoeptorship portion — months Other comments on the length of the course, or the relationship of the didactic portion to the internship/preceptorship portion: r? I i rim @ng \j F a; J THANK YOUAGAIN tor making this national survey of nurse practitioners possible. Please return completed questionnaire in the envelope provided to: Study of Nurses in Extended Roles Dr. Harry A. Suitz Department of Social and Preventive Medicine 22“ Main Street Buffalo, New York 14214 9, 21 21 Appendix B EMPLOYER QUESTIONNAIRE 173 174 STUDY PHASE II O.M.B‘ No. 68573038 Approval Expires 331-76 STUDY OF NURSES IN EXTENDED ROLES‘ by The Department of Social and Preventive Medicine School of Medicine ,,W > State University of New Yor t gale Eli“: fig“ IIHIIIIIIIW ‘Supported by contract number N01 NU 34064 from the Division of Nursing, Bureau of Health Manpower, Health Resources Administration, Public Health Service, U. S. Department of Health, Education, and Welfare. PLEASE PRINT LEGIBLY 1a. 2a. 2b. APPENDIX B 175 u.M.u. N0. cow/um Approval Expires 331-76 Code No. STUDY OF NURSES IN EXTENDED ROLES Employer's Questionnaire In the table below, please check (X) all the categories of patients by type of care for our ractioe settin . TYPE OF CARE Emotional/ :2?“ Amssment Illness Health Now in the table below please check (X) on our letter to you 7:2:NTS Ammam Illness Health Care Chi'd'e" /////////////////// Which of the following were reasons for employing thfi nurse practitioner? Check all that apply. El DDDDDDDD other (specify) to increase the number of patients in the practice to allow physician(s) to spend more time on complex cases to increase physician’s time for other professional or leisure activity to take some of the "on call" load to provide for patients previously uncared for to increase the number of home visits provided by the practice to increase the amount of patient education provided to increase the amount of attention given to seoondary problems and symptoms Now go back to 23 and circle your most important reason. Circle (fl only. 176 STUDY PHASE II 3a. 3b. What have been the results of employing M nurse practitioner? Check all that apply. has increased the number of patients in the practice has decreased the number of patients in the practice has allowed physicianls) to spend more time on complex cases has increased physician’s time for other professional or leisure activity has taken some of the "on cell” load has allowed practice to provide for patients previously uncared for has increased the number of home visits provided by the practice has increased the amount of patient education provided has increased the amount of attention given to secondary problems and symptoms DDUDDDDUDD other (specify) Now go back to 3a and circle your M significant result. Circle m age. ‘ ‘h at your practice setting? Circle one numberfor each aspect below. How satisfied are you with each of the following aspects of this NP's‘ ‘ ‘ Neidler i cry Somewhat Satisfied nor SameMier Very Satisfied Dine (is/fed Dissatisfied Disastisfied (2) (3i (4) (5) i at i . a. integration of the NP's role with the ro mafiifimw Mimi others in the practice setting W 1 2 3 4 5 b. competency in carrying out nefii _ 1 2 3 4 5 . iiiimaé‘fib c. adequacy of NP‘s productivity (relationship between fiscal cost/benefits she provides) 1 2 3 4 5 a. type of patients NP is caring for 1 2 3 4 5 e. number of patients NP is caring for 1 2 3 4 5 f. taking all things into consideration, how satisfied are you with Lis NP 1 2 3 4 5 APPENDIX B 177 Which, if any, of the following do you feel are barriers to practice that have influenced the role development of th_is NP? Please check all that apply. lack of confidence/willingness in taking on the responsibilities of the new role legal restrictions resistance from other health providers in the practice resistance from health providers outside the practice (including professional organizations. groups, as well as individuals) resistance from patients, consumer groups too fe_w patients to practice in this role satisfactorily too m patients to practice in this role satisfactorily lack of appropriate job classification within your institution or agency limitations of space and/or facilities other barriers (specify) D I] EIDUDEIDDUEI does not apply - no barriers Do you feel that the benefits of having dis NP outweigh the costs? (:1 yes [I no If n_n, check all the reasons that apply. nurse practitioner offers nonreimbursecl services nurse practitioner performs skills more slowly or ne time of nurse practitioner is not yet filled to m salary is excessive for level of performance nurse practitioner appears to need additio nurse practitioner’ s personality unsuited t n of results than MD vitv to fulfill role (3 DDDDDD other (specify) ) ‘ figa‘én E To what extent has th_is NP been ac diififimnflllv role by each of the following persons or groups in your practice setting? of WEEEHM‘MWL Check m response for each cate 0% below. ‘ NP Role Negative Don 't Know/ 6/: Well Fairly Well Response Does Not Persons Accepted Accepted ro NP Role Apply Physician Administrators Nurse Administrators (including supervisors) Nonclinical Administrators Physicians RNs (including PHNS, NPs) Other Nursing Personnel Clerical Staff Patients People in Community Pharmacists 178 STUDY PHASE 11 Which. if any, of the following have occurred in conjunction with the employment of this nurse practitioner. Check (X) all that apply. dtange in type of ownership of the practice setting establishment of a relationship with an educational or other institution chance in physical plant of practice setting (remodeling. expansion, relocation) addition of new practice units (e.g., a satellite clinic, new clinic unit) pattern of flow of the patients through the practice increase in clerical staff increase in technical staff decrease in technical staff increase in professional staff decrease in professional staff change in source of funds "office hours” reduced ”office hours" extended other L . (specify) E] DDDDDUUDDDDDDD does not apply Other comments related to adding Lis nurse practitioner to your pram Name of r ‘ first Title: Profession: D physician CiW D other (specifyi Name of practice setting: Address: no. and street city county sate zip Date questionnaire completed: month day year THANK YOU for making this national survey of nurse practitioners possible by completing this questionnaire. Please return completed questionnaire in the envelope provided to: Study of Nurses in Extended Roles Dr. Harry A. Sultz Department of Social and Preventive Medicine 2211 Main Street Buffalo, New York 14214 1} US. GOVERNMENT PRINTING OFFICE: 1979 0—274—911 DEPARTMENT OF HEALTH. EDUCATION. AND WELFARE PUBLIC HEALTH SERVICE POSTAGE AND rus PAID HEALTH RESOURCES ADMINISTRATION ”'5' DEMMMENY °F ”‘E‘w‘ HEW-396 HVATTSVILLE, MARYLAND 20782 OFFICIAL ausmsss PENALTY FOR mvne us: 3300 BHM DHEW Publication No. 78-92 H R A (”0255256110