Nurse practitioner perceptions of facilitators and constraints to practice

The purpose of this study was to identify and explain conditions that served to constrain and/or facilitate the practice of Veterans Administration (VA) nurse practitioners (NPs). A 60% stratified random sample of all full-time VA NPs was surveyed. The sample represented NPs from the four hospital complexity levels and six geographic regions. A 92% response rate was obtained for a sample of 257 NPs. On the whole, VA NPs appeared to experience more facilitation than constraint. Areas that seemed to be especially positive for VA NPs were related to the direct delivery of care, and areas that interfered with their practice were related to administrative issues. NP practice is facilitated if there is a feeling of status, opportunity for professional growth, and NP personal satisfaction. Status can be influenced by independence in practice, support from top nurse administrators, and enough clerical support. Professional growth can be enhanced by providing opportunities for continuing education, research, physician back-up, and medical center committee membership. Personal satisfaction may be promoted through job security, independence in practice, fringe benefits, continuity of caseload, and opportunity for promotion. Throughout the analyses, independence repeatedly surfaced as an important criterion in the facilitation of NP practice.