Nurse Practitioner Role and Practice Environment in Primary and in Nonprimary Care in California


Shira Winters, Susan A. Chapman, Garrett K. Chan, Karen Duderstadt, and Joanne Spetz

July 23, 2020

The nurse practitioner (NP) role has evolved substantially from its origins in primary care, with NPs increasingly being employed in the medical and surgical specialties. Between 2008 and 2016, there was an increase in nurse practitioners in specialty care. This study explores some differences in role and practice environment between primary care and nonprimary care nurse practitioners in the domains of time spent on activities, barriers to providing care, working to scope of practice, full skill utilization, and satisfaction.

This cross-sectional quantitative study, based on data from the 2017 Survey of California Nurse Practitioners and Certified Nurse Midwives, found that nurse practitioners in nonprimary care practices have lower odds of reporting time as a barrier to practice, lower odds of reporting practice to full scope, and higher odds of reporting a hierarchical or supervisory relationship with the physician. Future exploration of these differences may shed light on ways to promote nonprimary care practice environments to foster more effective collaboration and fewer barriers to providing care.