Increased Nurse Practitioner Autonomy Improves Teamwork With Physicians

Nurse practitioners’ (NPs) autonomy and independence in caring for patients and the good relationships they have with healthcare administrators improves their teamwork with physicians, according to a study from Columbia University School of Nursing investigators.

The study authors, Lusine Poghosyan, PhD, assistant professor at Columbia University School of Nursing, and Jianfang Liu, PhD, a senior data analyst affiliated with the school, believe the findings have significance for patient care because previous studies have shown that health outcomes are significantly better for patients who receive care from teams rather than from individual clinicians, especially when team members regularly interact and have a shared team vision. Controversy exists regarding the expanding role of NPs in primary are in terms of challenging the teamwork between NPs and physicians, the authors note.

The study, “Nurse Practitioners Autonomy and Relationships with Leadership Affect Teamwork in Primary Care Practices: a Cross-Sectional Survey,” was published in the July 2016 issue of Journal of General Internal Medicine. The investigators used professional questionnaires to measure NPs’ sense of teamwork with physicians, self-assessment of their professional autonomy, and their assessment of their relationships with institutional leadership. Questionnaires included the following survey statements:

• NPs do not have to discuss every patient care detail with a physician
• My organization creates an environment for NPs to practice independently
• Administrators are open to NPs’ ideas on improving patient care
• Administrators share information equally with NPs and physicians
• NPs feel valued by physicians
• NPs and physicians collaborate to provide patient care
• Physicians support NPs’ patient care decisions

The survey was returned by 314 NPs who worked in hospital-based clinics, community health centers, and physicians’ offices. The Autonomy and Independent Practice (AIP) and NP-Administration Relations (NP-AR) scales were used to measure NP independent practice and the relationships with leadership, respectively. Measures were aggregated to the practice level. Teamwork between NPs and physicians was measured at the level of the individual NP using the Teamwork scale.

The authors used multilevel linear regression models to investigate the influence of practice-level NP autonomy and the relationship between NPs and leadership on teamwork. With every unit increase on the practice-level mean score of AIP centered at the grand mean, the mean Teamwork score increased by 0.271 units (P <.0001). With every unit increase of NP-AR centered at the grand mean, the mean Teamwork score increased by 0.375 (P <.001).

“We know that team-delivered care is better for patients,” Poghosyan said in a statement. “We found that this can be achieved when NPs’ ability to deliver care independently is encouraged and when NPs perceive they are viewed and treated by administrators as integral members of the care teams.”

The study is one of the first to directly explore possible contributors to a sense of teamwork among NPs and physicians as well as demonstrate what factors within primary care practices affect teamwork.