postgraduate np education: impact on job satisfaction
TRANSCRIPT
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Postgraduate NP Education: Impact on Job Satisfaction
Tom Bush, DNP, FNP-BC, FAANP
Associate Professor
University of North Carolina at Chapel Hill
Schools of Nursing and Medicine
Orthopedic NP Fellowship Director
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IOM/RWJ Future of NursingState boards of nursing, accrediting bodies, the federal government, and health care organizations should take actions to support nurses completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas
IOM, 2011, p. S 9
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Fellowship or Residency?Residency is required for licensure and practice in medicine and some other disciplines
Post-graduate education is optional for licensure and practice in nursing
NP Roundtable Address potential confusion Endorsed use of the term fellowship
Transition-to-practice Does not suggest regulatory control
AANP 2013; Wiltse Nicely & Fairman, 2015
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Affordable Care ActPost-graduate NP demonstration project Fund FQHC programs in nurse managed health centers DHHS sought input from nursing educators NONPF & others voted not to support
We thought the money should go to support NP programs to increase the number of NPs
DHHS funded 5 health centers to increase numbers of NP graduates
No funding for post-graduate NP education
Boyar, 2010; M. Price 2014
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Cost and CommitmentPost-graduate physician education Federally funded by DHHS through CMS
More than 100k per resident per year Can total more than 500k when state Medicaid payments considered
Indirect Federal support for NP programs Veterans Health Administration Federally Qualified Health Centers
Few employer funded NP programs Most employers expect new NP graduates to perform at an advanced level
with little support
Dower, 2012; Bahouth, Blum, & Simone, 2013
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Cost and CommitmentMost post-graduate NP education programs employer funded Recruitment and retention of professionals
Meet immediate and growing workforce needs Costs per trainee can reach 100k annually
NP salary/benefits, lost preceptor revenue, facility overhead and administrative expenses Two thirds support post-graduate NP One third supplements lost preceptor productivity Expenses offset through billable NP activity
Employment commitment may be required
Flinter, 2011; D. Taylor, 2014
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ProblemPrograms to facilitate Nurse Practitioner (NP) transition to practice have been developed at public and private institutions across the US and there is no published evidence of their influence on NP job satisfaction
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PurposeDetermine the impact of post-graduate education on job satisfaction among NPs
Project Question: Is there a difference in job satisfaction between NPs who have
completed post-graduate fellowship education and NPs who have not participated in formal post-graduate fellowship education?
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TheoryFrom Limbo to Legitimacy Anxiety and accomplishments of novice NPs Transition from student to clinician
Feelings of insecurity and illegitimacy Fear of errors and associated anxiety Impacts diagnostic reasoning & clinical decisions
Experience fosters confidence & competence Is anxiety due to transitional identity or inadequate environmental support?
Brown & Olshanksy, 1997
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MethodsA non-equivalent group design The Misener Nurse Practitioner Job Satisfaction Scale was administered
to two groups of nurse practitioners Formal post-graduate fellowship n = 80 No formal post-graduate fellowship n = 174
Demographic tool race; gender; age; years of NP experience, highest degree; practice zip code
Misener & Cox 2001
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Age Distribution All Participants
Boomer 31.5%
Gen X 43.9%
Gen Y 24.3%
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Age Distribution by Group
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Mean Years of NP Experience
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States Represented
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Median Satisfaction Scores
Table 1 Job Satisfaction Scores
Post-graduate education N Median Frequency of
satisfied and very satisfied
Yes 80 5 68.8% No 174 5 50.5%
Table 1
Job Satisfaction Scores
Post-graduate education
N
Median
Frequency of satisfied and very satisfied
Yes
80
5
68.8%
No
174
5
50.5%
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Satisfaction DistributionN = 254Mean = 189SD = 36
95 percent of responses are normally distributed
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Data AnalysisAnalysis: Independent samples t-test of factor scores to compare job
satisfaction between groups Compare and contrast post-graduate fellowship training effects within
demographic strata Multiple Linear Regression
Calculated to predict participants total job satisfaction based on years of NP experience, state regulatory environment and completion of a post-graduate education program
- Independent Samples t TestTable 2 Independent samples t test of factor scores and Cronbach alpha (N = 254) Post-graduate education Yes (n = 80) No (n = 174) Factors M SD M SD t Sig.(2 tailed) Collegiality 0.95 4.33 1.03 3.94 1.05 2.74 .007* Autonomy 0.91 4.93 0.75 4.57 0.87 3.19 .002* Interaction 0.87 4.72 0.76 4.42 0.82 2.79 .006* Growth 0.89 4.38 1.11 3.78 1.16 3.84
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Years of Experience
p = .030
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Years of Experience/Post-grad. Ed
Statistically significant in No post-graduate education group only (p = .019)
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Statistically insignificant
State Regulatory Environment
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State Regulation/Post-grad. Ed
Statistically insignificant
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Post-graduate Education
p < .001
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Regulation/Experience/Post-grad. Education
More than 3 years experience, post-graduate education & full practice authority
VS.
More than 3 years experience, post-graduate education & restricted practice
p = .018
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Multiple Linear Regression Table 3 Multiple linear regression predicting Total Job Satisfaction from regulatory environment, years of experience (Block 1) and post-graduate education (Block 2) t p value State regulatory environment -3.27 -.545 .587 Years of experience as a nurse practitioner .16 .531 .596 Post-graduate education -16.68 -2.972 .003* Note. R2 = .04. * p < .05.
Table 3
Multiple linear regression predicting Total Job Satisfaction from regulatory environment, years of experience (Block 1) and post-graduate education (Block 2)
t
p value
State regulatory environment
-3.27
-.545
.587
Years of experience as a nurse practitioner
.16
.531
.596
Post-graduate education
-16.68
-2.972
.003*
Note. R2 = .04.
* p < .05.
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LimitationsParticipants recruited by email invitation Indirectly through program directors
Comparison group recruited through an online community of professionals
Parametric tests on ordinal data may be considered a study limitation Distribution nearly normal with few outliers
Supports the use of parametric tests in this study
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Post-graduate NP Education Significance: Post-graduate fellowship training significantly impacts NP satisfaction with
professional growth, autonomy, collegiality and interaction Satisfaction with work time and job benefits is less apparent in this study
Knowledge of factors that influence job satisfaction is advantageous: NPs considering fellowship education Employers considering program development Policy makers
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ReferencesBoyar, K. L. (2010). Nurse practitioner residency programs and healthcare reform on ADVANCE for NPs & PAs. Retrieved from http://nurse-practitioners-and-physician-assistants.advanceweb.com/Features/Articles/Nurse-Practitioner-Residency-Programs-and-Healthcare-Reform.aspx
Brown, M., & Olshansky, E. F. (1997). From limbo to legitimacy: A theoretical model of the transition to the primary care nurse practitioner role. Nursing Research, 46(1), 46-51.
Dower, C., & Christian, S. (2009). Physician assistants and nurse practitioners in specialty care: Six practices make it work. San Francisco: University of California.
Flinter, M. (2011). From new nurse practitioner to primary care provider: Bridging the transition through FQHC-based residency training. Online Journal of Issues in Nursing, 17(1), 6.
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ReferencesKapu, A. N., Kleinpell, R., & Pilon, B. (2014). Quality and financial impact of adding nurse practitioners to inpatient care teams. The Journal of Nursing Administration, 44(2), 87-96. doi:10.1097/NNA.0000000000000031; 10.1097/NNA.0000000000000031
IOM (Institute of Medicine). (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.
Landivar, L. (2013). Men in nursing occupations. Washington, DC: U.S. Census Bureau.
Misener, T. R., & Cox, D. L. (2001). Development of the misener nurse practitioner job satisfaction scale.Journal of Nursing Measurement, 9(1), 91-108.
Wilcox, M. A., Broyhill, B. H., Taylor, D. A., & Williamson, S. B. (2015). The lifecycle of the advanced clinical practitioner. Nurse Leader, 13(2), 27-30. doi:http://dx.doi.org/10.1016/j.mnl.2015.01.015
Wiltse Nicely, K. L., & Fairman, J. (2015). Postgraduate nurse practitioner residency programs: Supporting transition to practice. Academic Medicine : Journal of the Association of American Medical Colleges, 90(6), 707-709. doi:10.1097/ACM.0000000000000567 [doi]
Postgraduate NP Education: Impact on Job SatisfactionIOM/RWJ Future of NursingFellowship or Residency?Affordable Care ActCost and CommitmentCost and CommitmentProblemPurposeTheoryMethodsAge Distribution All ParticipantsAge Distribution by GroupMean Years of NP ExperienceStates Represented Median Satisfaction ScoresSatisfaction DistributionData AnalysisIndependent Samples t TestYears of Experience Years of Experience/Post-grad. EdState Regulatory EnvironmentState Regulation/Post-grad. EdPost-graduate EducationRegulation/Experience/Post-grad. EducationMultiple Linear Regression LimitationsPost-graduate NP Education ReferencesReferences